Provider Demographics
NPI:1003195876
Name:SOUTHEAST TEXAS ANESTHESIA LLP
Entity type:Organization
Organization Name:SOUTHEAST TEXAS ANESTHESIA LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:SANDERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:409-838-0411
Mailing Address - Street 1:3420 FANNIN ST
Mailing Address - Street 2:SUITE 190
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77701-3809
Mailing Address - Country:US
Mailing Address - Phone:409-838-0411
Mailing Address - Fax:409-838-9032
Practice Address - Street 1:3420 FANNIN ST
Practice Address - Street 2:SUITE 190
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77701-3809
Practice Address - Country:US
Practice Address - Phone:409-838-0411
Practice Address - Fax:409-838-9032
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-11
Last Update Date:2011-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty