MEDICARE: IN LINE ANESTHESIA SERVICES LP

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	047047	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	047047	OTHER	TX	AANA

General Provider Information

NPI Number	:	1598173783
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	IN LINE ANESTHESIA SERVICES LP

Provider Business Mailing Address
First Line	:	PO BOX 70289
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77270
Country	:	US
Telephone Number	:	173-291-4188
Fax Number	:

Provider Business Practice Location Address
First Line	:	3618 STANFORD ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77006-4644
Country	:	US
Telephone Number	:	713-291-4188
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DAVID ALAN ISAACS
Credential	:	CRNA
Telephone Number	:	713-291-4188

Provider Enumeration Date	:	07/31/2014
Last Update Date	:	07/31/2014

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