Provider Demographics
NPI:1790808707
Name:GOODWILL ANESTHESIA SERVICES, P.A.
Entity Type:Organization
Organization Name:GOODWILL ANESTHESIA SERVICES, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PRAMODH
Authorized Official - Middle Name:KUMAR
Authorized Official - Last Name:WADERA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-265-0774
Mailing Address - Street 1:PO BOX 16404
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77496-6404
Mailing Address - Country:US
Mailing Address - Phone:281-265-0774
Mailing Address - Fax:281-265-0774
Practice Address - Street 1:303 SANDY CORNER RD
Practice Address - Street 2:
Practice Address - City:EL CAMPO
Practice Address - State:TX
Practice Address - Zip Code:77437-9535
Practice Address - Country:US
Practice Address - Phone:281-265-0774
Practice Address - Fax:281-265-0774
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-06
Last Update Date:2010-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG1575207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty