Provider Demographics
NPI:1770635377
Name:KANTEX ANESTHESIA SERVICES PLLC
Entity Type:Organization
Organization Name:KANTEX ANESTHESIA SERVICES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:V
Authorized Official - Last Name:GALES
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:575-532-7000
Mailing Address - Street 1:205 W BOUTZ RD BLDG 1
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88005-3259
Mailing Address - Country:US
Mailing Address - Phone:575-532-7000
Mailing Address - Fax:
Practice Address - Street 1:1815 N STANTON ST
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79902-3511
Practice Address - Country:US
Practice Address - Phone:575-532-7000
Practice Address - Fax:575-532-7006
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-17
Last Update Date:2009-06-17
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
NM700521098Medicare PIN