Provider Demographics
NPI:1457407207
Name:GREATER DALLAS ANESTHESIA &PAIN MANAGEMENT
Entity Type:Organization
Organization Name:GREATER DALLAS ANESTHESIA &PAIN MANAGEMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER-DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:TASNEEM
Authorized Official - Middle Name:K
Authorized Official - Last Name:AGHA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:940-458-2828
Mailing Address - Street 1:PO BOX 640
Mailing Address - Street 2:
Mailing Address - City:SANGER
Mailing Address - State:TX
Mailing Address - Zip Code:76266-0640
Mailing Address - Country:US
Mailing Address - Phone:940-458-2828
Mailing Address - Fax:940-458-2522
Practice Address - Street 1:105 N. STEMMONS FREEWAY
Practice Address - Street 2:SUITE 101
Practice Address - City:SANGER
Practice Address - State:TX
Practice Address - Zip Code:76266-0640
Practice Address - Country:US
Practice Address - Phone:940-458-2828
Practice Address - Fax:940-458-2522
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK4347174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8A4960OtherBC-BS PROVIDER#
TXG33056Medicare UPIN
TX8A4960OtherBC-BS PROVIDER#