MEDICARE: ACCESS ANESTHESIA, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	367500000X	Certified Registered Nurse Anesthetist		TX

General Provider Information

NPI Number	:	1063622199
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ACCESS ANESTHESIA, LLC

Provider Business Mailing Address
First Line	:	1832 CROOKED LN
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76112-4509
Country	:	US
Telephone Number	:	877-614-1322
Fax Number	:	817-496-0424

Provider Business Practice Location Address
First Line	:	1832 CROOKED LN
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76112-4509
Country	:	US
Telephone Number	:	877-614-1322
Fax Number	:	817-496-0424

Authorized Official
Title or Position	:	OWNER
Name	:	MR. JASON TYDLASKA
Credential	:	CRNA
Telephone Number	:	817-496-0749

Provider Enumeration Date	:	05/24/2007
Last Update Date	:	07/29/2014

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