Basic Information
| Provider Information | |||||||||
| NPI: | 1689182438 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | LAB ANESTHESIA PLLC | ||||||||
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| OtherOrganizationName: | LAB ANESTHESIA | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 660257 | ||||||||
| Address2: | |||||||||
| City: | BIRMINGHAM | ||||||||
| State: | AL | ||||||||
| PostalCode: | 352660257 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2059795882 | ||||||||
| FaxNumber: | 2059791248 | ||||||||
| Practice Location | |||||||||
| Address1: | 1902 MOORES LN | ||||||||
| Address2: | |||||||||
| City: | TEXARKANA | ||||||||
| State: | TX | ||||||||
| PostalCode: | 755034610 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9037927515 | ||||||||
| FaxNumber: | 9037918645 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/15/2018 | ||||||||
| LastUpdateDate: | 01/15/2018 | ||||||||
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| AuthorizedOfficialLastName: | SELLERS | ||||||||
| AuthorizedOfficialFirstName: | DAVID | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 9032781665 | ||||||||
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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 | TX | Y | 193400000X SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
No ID Information.