Provider Demographics
NPI:1255905790
Name:ROSELAND ANESTHESIA
Entity type:Organization
Organization Name:ROSELAND ANESTHESIA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:WAGES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:903-592-6000
Mailing Address - Street 1:2737 S BROADWAY AVE
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75701-5413
Mailing Address - Country:US
Mailing Address - Phone:903-592-6000
Mailing Address - Fax:903-592-3224
Practice Address - Street 1:1802 MOORES LN STE 200
Practice Address - Street 2:
Practice Address - City:TEXARKANA
Practice Address - State:TX
Practice Address - Zip Code:75503-4609
Practice Address - Country:US
Practice Address - Phone:903-306-0711
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-19
Last Update Date:2021-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty