Basic Information
| Provider Information | |||||||||
| NPI: | 1962943241 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PROGRESSIVE ANESTHESIA INSTITUTE PLLC | ||||||||
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| Address1: | PO BOX 797922 | ||||||||
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| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 753797922 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2145005755 | ||||||||
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| Practice Location | |||||||||
| Address1: | 17330 PRESTON RD | ||||||||
| Address2: | SUITE 200 D | ||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 752525997 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2145005755 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/20/2017 | ||||||||
| LastUpdateDate: | 03/20/2017 | ||||||||
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| AuthorizedOfficialLastName: | FELDHENDLER | ||||||||
| AuthorizedOfficialFirstName: | MOSHE | ||||||||
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| AuthorizedOfficialTitleorPosition: | ADMIN | ||||||||
| AuthorizedOfficialTelephone: | 2145005755 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367H00000X | 553146 | TX | Y | 193400000X SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Anesthesiologist Assistant |
No ID Information.