Provider Demographics
NPI:1720404536
Name:TEXAS STAR ANESTHESIA MANAGEMENT, LLP
Entity Type:Organization
Organization Name:TEXAS STAR ANESTHESIA MANAGEMENT, LLP
Other - Org Name:TEXAS STAR ANESTHESIA MANAGEMENT,LLP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:GENERAL MANAGING PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JERRON
Authorized Official - Middle Name:CARLYLE
Authorized Official - Last Name:HILL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:214-437-4801
Mailing Address - Street 1:PO BOX 702097
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75370-2097
Mailing Address - Country:US
Mailing Address - Phone:214-437-4801
Mailing Address - Fax:972-377-3473
Practice Address - Street 1:4020 MCEWEN RD
Practice Address - Street 2:SUITE 177
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75244-5019
Practice Address - Country:US
Practice Address - Phone:214-437-4801
Practice Address - Fax:972-377-3473
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-17
Last Update Date:2014-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL4969173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes173000000XOther Service ProvidersLegal MedicineGroup - Single Specialty