Basic Information
| Provider Information | |||||||||
| NPI: | 1720074305 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | WEATHERFORD ANESTHESIA ASSOCIATES, PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 925 SANTA FE DR | ||||||||
| Address2: | SUITE 111 | ||||||||
| City: | WEATHERFORD | ||||||||
| State: | TX | ||||||||
| PostalCode: | 760865866 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8175994901 | ||||||||
| FaxNumber: | 8175994902 | ||||||||
| Practice Location | |||||||||
| Address1: | 925 SANTA FE DR | ||||||||
| Address2: | SUITE 111 | ||||||||
| City: | WEATHERFORD | ||||||||
| State: | TX | ||||||||
| PostalCode: | 760865866 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8175994901 | ||||||||
| FaxNumber: | 8175994902 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/20/2005 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | POSEY | ||||||||
| AuthorizedOfficialFirstName: | BENTON | ||||||||
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| AuthorizedOfficialTitleorPosition: | BUSINESS DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 8175994901 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | 207L00000X | TX | Y | 193400000X SINGLE SPECIALTY GROUP | Other Service Providers | Specialist |
No ID Information.