Provider Demographics
NPI:1790172187
Name:MINT ANESTHESIA, PLLC
Entity Type:Organization
Organization Name:MINT ANESTHESIA, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NELSON
Authorized Official - Middle Name:ATEMBE
Authorized Official - Last Name:TAJONG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-530-5310
Mailing Address - Street 1:690 S LOOP 336 W
Mailing Address - Street 2:SUITE 215
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77304-3319
Mailing Address - Country:US
Mailing Address - Phone:936-228-9980
Mailing Address - Fax:
Practice Address - Street 1:690 S LOOP 336 W
Practice Address - Street 2:SUITE 215
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77304-3319
Practice Address - Country:US
Practice Address - Phone:936-228-9980
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-23
Last Update Date:2015-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty