Provider Demographics
NPI:1457495194
Name:SELMER ANESTHESIA SERVICES LLC
Entity Type:Organization
Organization Name:SELMER ANESTHESIA SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TERRENCE
Authorized Official - Middle Name:BRANDON
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-941-0940
Mailing Address - Street 1:1503 ABBEVILLE DR
Mailing Address - Street 2:
Mailing Address - City:WYLIE
Mailing Address - State:TX
Mailing Address - Zip Code:75098-8496
Mailing Address - Country:US
Mailing Address - Phone:972-941-0940
Mailing Address - Fax:972-941-6705
Practice Address - Street 1:1503 ABBEVILLE DR
Practice Address - Street 2:
Practice Address - City:WYLIE
Practice Address - State:TX
Practice Address - Zip Code:75098-8496
Practice Address - Country:US
Practice Address - Phone:972-941-0940
Practice Address - Fax:972-941-6705
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management