Provider Demographics
NPI:1649676024
Name:CHAMPION ANESTHESIA CONSULTANTS, PLLC
Entity type:Organization
Organization Name:CHAMPION ANESTHESIA CONSULTANTS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:TYE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:817-657-2030
Mailing Address - Street 1:7167 COLLEYVILLE BLVD STE 104
Mailing Address - Street 2:
Mailing Address - City:COLLEYVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:76034-8002
Mailing Address - Country:US
Mailing Address - Phone:817-657-2030
Mailing Address - Fax:
Practice Address - Street 1:421 E STATE HIGHWAY 114
Practice Address - Street 2:
Practice Address - City:SOUTHLAKE
Practice Address - State:TX
Practice Address - Zip Code:76092-3635
Practice Address - Country:US
Practice Address - Phone:817-865-4516
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-12
Last Update Date:2023-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty