Basic Information
| Provider Information | |||||||||
| NPI: | 1346785854 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NORTH TEXAS ANESTHETISTS, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 272682 | ||||||||
| Address2: | |||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 772772682 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7134878910 | ||||||||
| FaxNumber: | 7135834325 | ||||||||
| Practice Location | |||||||||
| Address1: | 2452 LAKEWOOD DR | ||||||||
| Address2: | |||||||||
| City: | GRAND PRAIRIE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750546800 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9727432126 | ||||||||
| FaxNumber: | 2149882082 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/20/2016 | ||||||||
| LastUpdateDate: | 12/20/2016 | ||||||||
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| AuthorizedOfficialLastName: | HOWINGTON | ||||||||
| AuthorizedOfficialFirstName: | ROBERT | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER/ PROVIDER | ||||||||
| AuthorizedOfficialTelephone: | 9727432126 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| AuthorizedOfficialCredential: | CRNA | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | 70862 | TX | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
No ID Information.