Basic Information
| Provider Information | |||||||||
| NPI: | 1639167810 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ANESTHESIA SPECIALISTS OF HOUSTON, L.L.P. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7900 FANNIN ST | ||||||||
| Address2: | SUITE 2300 | ||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770542900 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7137901349 | ||||||||
| FaxNumber: | 7137900028 | ||||||||
| Practice Location | |||||||||
| Address1: | 7900 FANNIN ST | ||||||||
| Address2: | SUITE 2300 | ||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770542900 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7137901349 | ||||||||
| FaxNumber: | 7137900028 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/11/2005 | ||||||||
| LastUpdateDate: | 12/30/2010 | ||||||||
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| AuthorizedOfficialLastName: | GONZALEZ | ||||||||
| AuthorizedOfficialFirstName: | PATRICIA | ||||||||
| AuthorizedOfficialMiddleName: | H | ||||||||
| AuthorizedOfficialTitleorPosition: | PRACTICE MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 7137901349 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | MT-41 | 01 | TX | BLUE CROSS BLUE SHIELD | OTHER | 090118302 | 05 | TX | MEDICAID |