Basic Information
| Provider Information | |||||||||
| NPI: | 1114315306 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PROGRESSIVE ANESTHESIA SERVICES, PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 890228 | ||||||||
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| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 772890228 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 1113 WEST BAKER ROAD SUITE G | ||||||||
| Address2: | |||||||||
| City: | BAYTOWN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 775212391 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2819933733 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/23/2014 | ||||||||
| LastUpdateDate: | 01/30/2015 | ||||||||
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| AuthorizedOfficialLastName: | QAYYUM | ||||||||
| AuthorizedOfficialFirstName: | MOHSIN | ||||||||
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| AuthorizedOfficialTitleorPosition: | MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 2819933733 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology | 367H00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Anesthesiologist Assistant |
No ID Information.