MEDICARE: U S ANESTHESIA PARTNERS OF TEXAS

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	207L00000X	Anesthesiology Physician
2	363A00000X	Physician Assistant
3	363L00000X	Nurse Practitioner
4	367500000X	Certified Registered Nurse Anesthetist
5	208VP0014X	Interventional Pain Medicine Physician

General Provider Information

NPI Number	:	1700333101
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	U S ANESTHESIA PARTNERS OF TEXAS

Provider Business Mailing Address
First Line	:	PO BOX 650865
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75265-0865
Country	:	US
Telephone Number	:	972-715-1999
Fax Number	:	972-715-1996

Provider Business Practice Location Address
First Line	:	3160 N TARRANT PKWY
Second Line	:	SUITE 404
City	:	FT WORTH
State	:	TX
Zip	:	76177-8614
Country	:	US
Telephone Number	:	817-468-4343
Fax Number	:	817-468-8765

Authorized Official
Title or Position	:	DIRECTOR OF CREDENTIALING
Name	:	TIFFANY JOLLEY
Credential	:
Telephone Number	:	713-620-4000

Provider Enumeration Date	:	09/02/2016
Last Update Date	:	09/02/2016

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