Provider Demographics
NPI:1942698337
Name:SOUTHWEST FORT WORTH ANESTHESIA CONSULTANTS, PA
Entity Type:Organization
Organization Name:SOUTHWEST FORT WORTH ANESTHESIA CONSULTANTS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:C
Authorized Official - Middle Name:GORDON
Authorized Official - Last Name:MCADAMS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:817-861-3994
Mailing Address - Street 1:4100 INTERNATIONAL PLZ
Mailing Address - Street 2:SUITE 600
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76109-4820
Mailing Address - Country:US
Mailing Address - Phone:817-334-0530
Mailing Address - Fax:817-529-1481
Practice Address - Street 1:4100 INTERNATIONAL PLZ
Practice Address - Street 2:SUITE 600
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76109-4820
Practice Address - Country:US
Practice Address - Phone:817-334-0530
Practice Address - Fax:817-529-1481
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-07
Last Update Date:2015-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty
No367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Multi-Specialty