Provider Demographics
NPI:1720628936
Name:SOUTHERN GROUP ANESTHESIA PLLC
Entity Type:Organization
Organization Name:SOUTHERN GROUP ANESTHESIA PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:RENATA
Authorized Official - Middle Name:
Authorized Official - Last Name:PEREIRA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:979-549-1131
Mailing Address - Street 1:801 FM 1463 RD STE 200
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77494-7925
Mailing Address - Country:US
Mailing Address - Phone:361-237-1072
Mailing Address - Fax:
Practice Address - Street 1:1259 FM 1463 RD STE 500
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77494-5470
Practice Address - Country:US
Practice Address - Phone:361-237-1072
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-15
Last Update Date:2020-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty