Provider Demographics
NPI:1699813808
Name:QUELCH ANESTHESIA SERVICES, LTD
Entity Type:Organization
Organization Name:QUELCH ANESTHESIA SERVICES, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:QUELCH
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:915-779-1716
Mailing Address - Street 1:5959 GATEWAY BLVD W
Mailing Address - Street 2:STE. 120
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79925-3331
Mailing Address - Country:US
Mailing Address - Phone:915-779-1719
Mailing Address - Fax:915-771-6558
Practice Address - Street 1:5959 GATEWAY BLVD W
Practice Address - Street 2:STE. 120
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79925-3331
Practice Address - Country:US
Practice Address - Phone:915-779-1719
Practice Address - Fax:915-771-6558
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-01
Last Update Date:2014-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00C64ROtherBCBS
TX152783001Medicaid
TX152783001Medicaid