Provider Demographics
NPI:1205810843
Name:WHARTON ANESTHESIA PA
Entity type:Organization
Organization Name:WHARTON ANESTHESIA PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:ZBORIL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-481-3533
Mailing Address - Street 1:PO BOX 1276
Mailing Address - Street 2:
Mailing Address - City:STEPHENVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:76401-0012
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:411 N BELKNAP ST
Practice Address - Street 2:
Practice Address - City:STEPHENVILLE
Practice Address - State:TX
Practice Address - Zip Code:76401-3415
Practice Address - Country:US
Practice Address - Phone:713-481-3533
Practice Address - Fax:713-432-0221
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-06
Last Update Date:2009-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX050006528OtherRAILROAD MEDICARE
TX050006528OtherRAILROAD MEDICARE