Provider Demographics
NPI:1790189421
Name:SUITE DREAMS ANESTHESIA & AESTHETIC SURGICAL CONSULTANTS
Entity Type:Organization
Organization Name:SUITE DREAMS ANESTHESIA & AESTHETIC SURGICAL CONSULTANTS
Other - Org Name:AESTHETIC SURGICAL INSTITUTE
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:BECK
Authorized Official - Suffix:
Authorized Official - Credentials:DNP, CRNA
Authorized Official - Phone:817-938-1799
Mailing Address - Street 1:2704 WARWICK DR
Mailing Address - Street 2:
Mailing Address - City:CORINTH
Mailing Address - State:TX
Mailing Address - Zip Code:76210-6488
Mailing Address - Country:US
Mailing Address - Phone:817-938-1799
Mailing Address - Fax:940-498-1374
Practice Address - Street 1:2704 WARWICK DR
Practice Address - Street 2:
Practice Address - City:CORINTH
Practice Address - State:TX
Practice Address - Zip Code:76210-6488
Practice Address - Country:US
Practice Address - Phone:817-938-1799
Practice Address - Fax:940-498-1374
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-09
Last Update Date:2015-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
163W00000X, 261QP3300X
TX261QA1903X
TXAP121487367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Multi-Specialty
No163W00000XNursing Service ProvidersRegistered NurseGroup - Multi-Specialty
No261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
No261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPainGroup - Multi-Specialty