Provider Demographics
NPI:1821080284
Name:ALPHA OMEGA ANESTHESIA ASSOCIATES, PLLC
Entity Type:Organization
Organization Name:ALPHA OMEGA ANESTHESIA ASSOCIATES, PLLC
Other - Org Name:WEEKEND ANESTHESIA ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:DANA
Authorized Official - Middle Name:YVONNE
Authorized Official - Last Name:BROOKS
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA, MSN, MHS
Authorized Official - Phone:214-550-5283
Mailing Address - Street 1:1301 E DEBBIE LN
Mailing Address - Street 2:SUITE 102-144
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-3305
Mailing Address - Country:US
Mailing Address - Phone:214-550-5283
Mailing Address - Fax:866-842-4031
Practice Address - Street 1:600 STRADA CIR
Practice Address - Street 2:SUITE U
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063-3201
Practice Address - Country:US
Practice Address - Phone:214-550-5283
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-21
Last Update Date:2009-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX505356163W00000X, 163WA2000X, 163WC0200X, 163WC1600X, 171W00000X, 367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty
No163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty
No163WA2000XNursing Service ProvidersRegistered NurseAdministratorGroup - Single Specialty
No163WC0200XNursing Service ProvidersRegistered NurseCritical Care MedicineGroup - Single Specialty
No163WC1600XNursing Service ProvidersRegistered NurseContinuing Education/Staff DevelopmentGroup - Single Specialty
No171W00000XOther Service ProvidersContractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8C7033Medicare ID - Type UnspecifiedINDIVIDUAL RENDERING
TX00498XMedicare ID - Type UnspecifiedGROUP NUMBER