Provider Demographics
NPI:1184719650
Name:BABCOCK ANESTHESIA PROVIDERS PC
Entity type:Organization
Organization Name:BABCOCK ANESTHESIA PROVIDERS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KENT
Authorized Official - Middle Name:K
Authorized Official - Last Name:BABCOCK
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:979-966-0321
Mailing Address - Street 1:353 N MADISON
Mailing Address - Street 2:
Mailing Address - City:LA GRANGE
Mailing Address - State:TX
Mailing Address - Zip Code:78945-2231
Mailing Address - Country:US
Mailing Address - Phone:979-966-0321
Mailing Address - Fax:979-968-2722
Practice Address - Street 1:353 N MADISON
Practice Address - Street 2:
Practice Address - City:LA GRANGE
Practice Address - State:TX
Practice Address - Zip Code:78945-2231
Practice Address - Country:US
Practice Address - Phone:979-966-0321
Practice Address - Fax:979-968-2722
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2008-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX036116367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX152078501Medicaid
TX00C47POtherBCBS
TX00898RMedicare ID - Type Unspecified