Basic Information
| Provider Information | |||||||||
| NPI: | 1366809295 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MAC-BAR ANESTHESIA PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2438 INDUSTRIAL BLVD | ||||||||
| Address2: | PMB 166 | ||||||||
| City: | ABILENE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 796057207 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3256756466 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2120 ANTILLEY RD | ||||||||
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| City: | ABILENE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 796065211 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3256756466 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/22/2016 | ||||||||
| LastUpdateDate: | 05/27/2022 | ||||||||
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| AuthorizedOfficialLastName: | PONDER | ||||||||
| AuthorizedOfficialFirstName: | AMBER | ||||||||
| AuthorizedOfficialMiddleName: | DAWN | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 3256756466 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | DNAP, CRNA | ||||||||
| NPICertificationDate: | 05/27/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | Y | 193400000X SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
No ID Information.