Provider Demographics
NPI:1750911848
Name:MAGNOLIA ANESTHESIA MANAGEMENT LLC
Entity type:Organization
Organization Name:MAGNOLIA ANESTHESIA MANAGEMENT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:SILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-234-4740
Mailing Address - Street 1:7920 BELT LINE RD STE 940
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75254-8151
Mailing Address - Country:US
Mailing Address - Phone:972-234-4740
Mailing Address - Fax:972-231-7095
Practice Address - Street 1:3075 W SOUTHLAKE BLVD
Practice Address - Street 2:
Practice Address - City:SOUTHLAKE
Practice Address - State:TX
Practice Address - Zip Code:76092-6730
Practice Address - Country:US
Practice Address - Phone:972-234-4740
Practice Address - Fax:972-231-7095
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-17
Last Update Date:2020-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty