Basic Information
| Provider Information | |||||||||
| NPI: | 1740534148 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MORNINGSTAR ANESTHESIA PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 2626 | ||||||||
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| City: | FORT WORTH | ||||||||
| State: | TX | ||||||||
| PostalCode: | 761132626 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8172947444 | ||||||||
| FaxNumber: | 8172947172 | ||||||||
| Practice Location | |||||||||
| Address1: | 1511 HIGHWAY 34 S | ||||||||
| Address2: | |||||||||
| City: | TERRELL | ||||||||
| State: | TX | ||||||||
| PostalCode: | 751604833 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9725516820 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/07/2012 | ||||||||
| LastUpdateDate: | 11/07/2012 | ||||||||
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| AuthorizedOfficialLastName: | MORNINGSTAR | ||||||||
| AuthorizedOfficialFirstName: | JASON | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 8172947444 | ||||||||
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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 | 680673 | TX | Y | 193400000X SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
No ID Information.