MEDICARE: AST ANESTHESIA SERVICES OF TEXAS PLLC

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
2	207L00000X	Anesthesiology Physician

General Provider Information

NPI Number	:	1275289795
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AST ANESTHESIA SERVICES OF TEXAS PLLC

Provider Business Mailing Address
First Line	:	PO BOX 1889
Second Line	:
City	:	MUNCIE
State	:	IN
Zip	:	47308-1889
Country	:	US
Telephone Number	:	765-284-0493
Fax Number	:

Provider Business Practice Location Address
First Line	:	4800 FEDERAL PLZ
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77092-1704
Country	:	US
Telephone Number	:	713-462-3194
Fax Number	:

Authorized Official
Title or Position	:	AUTHORIZED OFFICIAL
Name	:	ROBERT CASIMIR
Credential	:	DO
Telephone Number	:	832-279-2369

Provider Enumeration Date	:	02/23/2022
Last Update Date	:	02/23/2022

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