Provider Demographics
NPI:1821154501
Name:PROFESSIONAL ANESTHESIA ASSOCIATES
Entity Type:Organization
Organization Name:PROFESSIONAL ANESTHESIA ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:BILL
Authorized Official - Middle Name:
Authorized Official - Last Name:FRIDDELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:432-837-7160
Mailing Address - Street 1:PO BOX 2052
Mailing Address - Street 2:
Mailing Address - City:ALPINE
Mailing Address - State:TX
Mailing Address - Zip Code:79831-2052
Mailing Address - Country:US
Mailing Address - Phone:432-837-7160
Mailing Address - Fax:432-837-7160
Practice Address - Street 1:2600 N HIGHWAY 118
Practice Address - Street 2:
Practice Address - City:ALPINE
Practice Address - State:TX
Practice Address - Zip Code:79830-2002
Practice Address - Country:US
Practice Address - Phone:432-837-7160
Practice Address - Fax:432-837-5450
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-28
Last Update Date:2009-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX553621367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00C10POtherGROUP BCBS OF TEXAS ID
TX006864501Medicaid
TX006864501Medicaid