Provider Demographics
NPI:1790008324
Name:ST. ANTHONYS ANESTHESIA PA
Entity Type:Organization
Organization Name:ST. ANTHONYS ANESTHESIA PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:DR
Authorized Official - First Name:MARC
Authorized Official - Middle Name:H
Authorized Official - Last Name:BOIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-348-0426
Mailing Address - Street 1:1075 KINGWOOD DR
Mailing Address - Street 2:SUITE 150
Mailing Address - City:KINGWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:77339-3010
Mailing Address - Country:US
Mailing Address - Phone:281-358-8114
Mailing Address - Fax:281-358-0609
Practice Address - Street 1:2807 LITTLE YORK RD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77093-3405
Practice Address - Country:US
Practice Address - Phone:713-697-7777
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-10
Last Update Date:2010-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0045TGOtherBCBS DOCTORS GROUP
TX00C65XOtherBCBS CRNAS GROUP