Provider Demographics
NPI:1932868544
Name:WHITETAIL ANESTHESIA ASSOCIATES
Entity Type:Organization
Organization Name:WHITETAIL ANESTHESIA ASSOCIATES
Other - Org Name:WHITETAIL ANESTHESIA ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF BILLING
Authorized Official - Prefix:
Authorized Official - First Name:SCHERON
Authorized Official - Middle Name:
Authorized Official - Last Name:WASHINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-435-4252
Mailing Address - Street 1:3140 LEGACY DR STE 310
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75034-9383
Mailing Address - Country:US
Mailing Address - Phone:972-435-4252
Mailing Address - Fax:214-975-1630
Practice Address - Street 1:3140 LEGACY DR STE 310
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75034-9383
Practice Address - Country:US
Practice Address - Phone:972-435-4252
Practice Address - Fax:214-975-1630
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-10
Last Update Date:2023-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty