Basic Information
| Provider Information | |||||||||
| NPI: | 1043516628 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NORTHSTAR ANESTHESIA OF OKLAHOMA, PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 224747 | ||||||||
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| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 752224747 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2396100775 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2000 E LAMAR BLVD STE 400 | ||||||||
| Address2: | |||||||||
| City: | ARLINGTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 760067353 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8178613994 | ||||||||
| FaxNumber: | 8178613926 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/31/2011 | ||||||||
| LastUpdateDate: | 05/25/2021 | ||||||||
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| AuthorizedOfficialLastName: | EICHENHOLZ | ||||||||
| AuthorizedOfficialFirstName: | PHILIP | ||||||||
| AuthorizedOfficialMiddleName: | W | ||||||||
| AuthorizedOfficialTitleorPosition: | CHAIRMAN CEO | ||||||||
| AuthorizedOfficialTelephone: | 8888613994 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | 05/25/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology |
No ID Information.