Basic Information
| Provider Information | |||||||||
| NPI: | 1356985972 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PATHFINDERS ANESTHESIA L.L.C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5729 LEBANON RD STE 144 | ||||||||
| Address2: | PMB 588 | ||||||||
| City: | FRISCO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750347259 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9724531879 | ||||||||
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| Practice Location | |||||||||
| Address1: | 5150 WARREN PKWY BLDG 8 | ||||||||
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| City: | FRISCO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750347462 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9724531879 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/06/2019 | ||||||||
| LastUpdateDate: | 11/06/2019 | ||||||||
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| AuthorizedOfficialLastName: | BROWN | ||||||||
| AuthorizedOfficialFirstName: | BRYAN | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | COO | ||||||||
| AuthorizedOfficialTelephone: | 9724531879 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | Y | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
ID Information
| ID | Type | State | Issuer | Description | 1356640262 | 01 | NPIS | OTHER | 1780155226 | 01 | TX | NPIS | OTHER |