Provider Demographics
NPI:1982644480
Name:TEXAS UNITED ANESTHESIA PLLC
Entity Type:Organization
Organization Name:TEXAS UNITED ANESTHESIA PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:D
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:936-639-3036
Mailing Address - Street 1:PO BOX 1141
Mailing Address - Street 2:
Mailing Address - City:DICKINSON
Mailing Address - State:TX
Mailing Address - Zip Code:77539-1141
Mailing Address - Country:US
Mailing Address - Phone:936-639-3036
Mailing Address - Fax:936-639-3064
Practice Address - Street 1:3810 HUGHES CT
Practice Address - Street 2:
Practice Address - City:DICKINSON
Practice Address - State:TX
Practice Address - Zip Code:77539-6205
Practice Address - Country:US
Practice Address - Phone:936-639-3036
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-07
Last Update Date:2008-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00C85POtherBCBS
TXCK7279Medicare PIN
TX00201UMedicare PIN