Basic Information
| Provider Information | |||||||||
| NPI: | 1578534087 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NORTHEASTERN ANESTHESIA SERVICES PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 388 | ||||||||
| Address2: | |||||||||
| City: | NEWTON | ||||||||
| State: | KS | ||||||||
| PostalCode: | 671140388 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3162813700 | ||||||||
| FaxNumber: | 3162824322 | ||||||||
| Practice Location | |||||||||
| Address1: | 803 W LAMPASAS | ||||||||
| Address2: | |||||||||
| City: | ENNIS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 75119 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9728750900 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/01/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | FROST | ||||||||
| AuthorizedOfficialFirstName: | ROGER | ||||||||
| AuthorizedOfficialMiddleName: | ALLAN | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 9728750900 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | CRNA | ||||||||
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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.