Provider Demographics
NPI:1679193197
Name:CELEBRITY ANESTHESIA PLLC
Entity Type:Organization
Organization Name:CELEBRITY ANESTHESIA PLLC
Other - Org Name:CELEBRITY ANESTHESIA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING PARTNER/CRNA
Authorized Official - Prefix:
Authorized Official - First Name:TRAVIS
Authorized Official - Middle Name:
Authorized Official - Last Name:OSBORNE
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:512-593-1945
Mailing Address - Street 1:3809 VALLEY VIEW RD BLDG 5
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78704-3375
Mailing Address - Country:US
Mailing Address - Phone:512-593-1945
Mailing Address - Fax:
Practice Address - Street 1:1402 HOMESPUN RD
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78745-3041
Practice Address - Country:US
Practice Address - Phone:512-924-1858
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-24
Last Update Date:2021-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty