Basic Information
| Provider Information | |||||||||
| NPI: | 1962874727 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ADDISON ANESTHESIA MANAGEMENT LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 674006 | ||||||||
| Address2: | |||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 752674006 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9724791115 | ||||||||
| FaxNumber: | 9724791118 | ||||||||
| Practice Location | |||||||||
| Address1: | 17051 DALLAS PKWY | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | ADDISON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750017109 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9722157410 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/20/2015 | ||||||||
| LastUpdateDate: | 06/06/2016 | ||||||||
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| AuthorizedOfficialLastName: | MCGILL | ||||||||
| AuthorizedOfficialFirstName: | KRISTY | ||||||||
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| AuthorizedOfficialTitleorPosition: | DIR OF NETWORK DEVELOPMENT | ||||||||
| AuthorizedOfficialTelephone: | 9722157410 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QP3300X | N | Ambulatory Health Care Facilities | Clinic/Center | Pain | 367500000X | Y | 193400000X SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
No ID Information.