Basic Information
| Provider Information | |||||||||
| NPI: | 1750594941 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | EDINBURG ANESTHESIA ASSOCIATION | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 3744 | ||||||||
| Address2: | |||||||||
| City: | MCALLEN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 785023744 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9566824151 | ||||||||
| FaxNumber: | 9566824154 | ||||||||
| Practice Location | |||||||||
| Address1: | 4228 N MCCOLL RD | ||||||||
| Address2: | |||||||||
| City: | MCALLEN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 785042523 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9566824151 | ||||||||
| FaxNumber: | 9566824154 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/07/2007 | ||||||||
| LastUpdateDate: | 04/15/2016 | ||||||||
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| AuthorizedOfficialLastName: | LIU | ||||||||
| AuthorizedOfficialFirstName: | YIXIANG | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 9566824151 | ||||||||
| 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 | 166684401 | 05 | TX | MEDICAID | 0081LE | 01 | TX | BCBS | OTHER | DC7471 | 01 | TX | MEDICARE RAILROAD | OTHER |