Basic Information
| Provider Information | |||||||||
| NPI: | 1669468922 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | RIVER OAKS ANESTHESIA CONSULTANTS PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1075 KINGWOOD DR | ||||||||
| Address2: | SUITE 150 | ||||||||
| City: | KINGWOOD | ||||||||
| State: | TX | ||||||||
| PostalCode: | 773393006 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2813588114 | ||||||||
| FaxNumber: | 2813580609 | ||||||||
| Practice Location | |||||||||
| Address1: | 4120 SOUTHWEST FWY | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770277339 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7136268500 | ||||||||
| FaxNumber: | 7136268560 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/22/2005 | ||||||||
| LastUpdateDate: | 11/06/2007 | ||||||||
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| AuthorizedOfficialLastName: | MORAGNE | ||||||||
| AuthorizedOfficialFirstName: | JOHN | ||||||||
| AuthorizedOfficialMiddleName: | EDWARD | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 7136268500 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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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 | 00979K | 01 | TX | BLUE CROSS BLUE SHIELD | OTHER | 00337N | 01 | TX | BLUE CROSS BLUE SHIELD | OTHER | CF8079 | 01 | TX | RAILROAD MEDICARE | OTHER |