Provider Demographics
NPI:1881760403
Name:NACAGDOCLES ANESTHESIA GROUP LLP
Entity type:Organization
Organization Name:NACAGDOCLES ANESTHESIA GROUP LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:G
Authorized Official - Last Name:HAIDINYAK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:936-564-9164
Mailing Address - Street 1:1329 N UNIVERSITY
Mailing Address - Street 2:SUITE E 1
Mailing Address - City:NACOGDOCLES
Mailing Address - State:TX
Mailing Address - Zip Code:75961
Mailing Address - Country:US
Mailing Address - Phone:936-564-9164
Mailing Address - Fax:936-560-2538
Practice Address - Street 1:1329 N UNIVERSITY
Practice Address - Street 2:SUITE E 1
Practice Address - City:NACOGDOCLES
Practice Address - State:TX
Practice Address - Zip Code:75961
Practice Address - Country:US
Practice Address - Phone:936-564-9164
Practice Address - Fax:936-560-2538
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMDF5222207L00000X
TX27202367500000X
TX227393367500000X
TX250536367500000X
TX244941367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty
Not Answered367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
244941OtherCOMMERCIAL
89970COtherBLUE CROSS
427202OtherCOM
89969COtherBLUE CROSS
F5222OtherCOMMERCIAL
83919UOtherBLUE CROSS
227393OtherCOMMERCIAL
88430XOtherBLUE CROSS
89968COtherBLUE CROSS
250536OtherCOMMERCIAL
82961HMedicare ID - Type Unspecified
88430XOtherBLUE CROSS
250536OtherCOMMERCIAL
227393OtherCOMMERCIAL
82962HMedicare ID - Type Unspecified