Provider Demographics
NPI:1770061574
Name:EXCEPTIONAL ANESTHESIA PLLC
Entity type:Organization
Organization Name:EXCEPTIONAL ANESTHESIA PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AGENT
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:GEROULO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-698-8027
Mailing Address - Street 1:7234 GASTON AVE STE 124-310
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75214-4124
Mailing Address - Country:US
Mailing Address - Phone:972-638-8803
Mailing Address - Fax:
Practice Address - Street 1:8604 GREENVILLE AVE STE 103A
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75243
Practice Address - Country:US
Practice Address - Phone:972-638-8803
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PAARLMED PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-08-02
Last Update Date:2018-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty