Basic Information
| Provider Information | |||||||||
| NPI: | 1447792700 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ENDO SEDATION LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 550 RESERVE ST STE 560 | ||||||||
| Address2: | |||||||||
| City: | SOUTHLAKE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 760921607 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8174027526 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2704 N GALLOWAY AVE STE 102 | ||||||||
| Address2: | |||||||||
| City: | MESQUITE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 751506379 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9729617171 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/17/2016 | ||||||||
| LastUpdateDate: | 10/11/2021 | ||||||||
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| AuthorizedOfficialLastName: | WHEELER | ||||||||
| AuthorizedOfficialFirstName: | BRANDI | ||||||||
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| AuthorizedOfficialTitleorPosition: | ANESTHESIA SUPPORT SERVICES COORD | ||||||||
| AuthorizedOfficialTelephone: | 8174027526 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 10/11/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology | 367500000X | Y | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
No ID Information.