Basic Information
| Provider Information | |||||||||
| NPI: | 1710047840 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | GARLAND ANESTHESIA CONSULTANTS, PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 975684 | ||||||||
| Address2: | |||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 753975684 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9722766100 | ||||||||
| FaxNumber: | 9722761231 | ||||||||
| Practice Location | |||||||||
| Address1: | 1721 ANALOG DR | ||||||||
| Address2: | |||||||||
| City: | RICHARDSON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750811944 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9722766100 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/11/2006 | ||||||||
| LastUpdateDate: | 01/03/2020 | ||||||||
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| AuthorizedOfficialLastName: | ORTIZ | ||||||||
| AuthorizedOfficialFirstName: | RAY | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 9722766100 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
| AuthorizedOfficialNameSuffix: | JR. | ||||||||
| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | 01/03/2020 | ||||||||
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 | 159462401 | 05 | TX | MEDICAID |