MEDICARE: MODERN ANESTHESIA ASSOCIATES

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

General Provider Information

NPI Number	:	1679345045
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MODERN ANESTHESIA ASSOCIATES

Provider Business Mailing Address
First Line	:	PO BOX 66791
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77266-6791
Country	:	US
Telephone Number	:	713-993-6053
Fax Number	:	866-810-8005

Provider Business Practice Location Address
First Line	:	800 WILCREST DR STE 213
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77042-1360
Country	:	US
Telephone Number	:	713-993-6053
Fax Number	:	866-810-8005

Authorized Official
Title or Position	:	CEO
Name	:	DAVID PROFIT JR.
Credential	:
Telephone Number	:	713-993-6053

Provider Enumeration Date	:	10/27/2023
Last Update Date	:	04/30/2025

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Directions to “MODERN ANESTHESIA ASSOCIATES ” Practice Location

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