Provider Demographics
NPI:1487792578
Name:METROWEST ANESTHESIA CARE
Entity type:Organization
Organization Name:METROWEST ANESTHESIA CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ANESTHESIOLOGIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:FULLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:713-242-3439
Mailing Address - Street 1:2222 MARONEAL ST UNIT 942
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-3264
Mailing Address - Country:US
Mailing Address - Phone:713-242-3439
Mailing Address - Fax:713-242-2200
Practice Address - Street 1:921 GESSNER RD
Practice Address - Street 2:SUITE 226
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77024-2501
Practice Address - Country:US
Practice Address - Phone:713-242-3439
Practice Address - Fax:713-242-2200
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXT0149759OtherDPS