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NPI Code Detail

MEDICARE: ST. ANTHONYS ANESTHESIA PA

MEDICARE: ST. ANTHONYS ANESTHESIA PA
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
1207L00000XAnesthesiology Physician

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
10045TGOTHERTXBCBS DOCTORS GROUP
200C65XOTHERTXBCBS CRNAS GROUP

General Provider Information

NPI Number : 1790008324
Entity Type Code : Organization
Provider Name (Legal Business Name) : ST. ANTHONYS ANESTHESIA PA
Provider Business Mailing Address
First Line : 1075 KINGWOOD DR
Second Line : SUITE 150
City : KINGWOOD
State : TX
Zip : 77339-3010
Country : US
Telephone Number : 281-358-8114
Fax Number : 281-358-0609
Provider Business Practice Location Address
First Line : 2807 LITTLE YORK RD
Second Line :
City : HOUSTON
State : TX
Zip : 77093-3405
Country : US
Telephone Number : 713-697-7777
Fax Number :
Authorized Official
Title or Position : AUTHORIZED OFFICIAL
Name : DR. MARC H. BOIN
Credential : M.D.
Telephone Number : 281-348-0426
Provider Enumeration Date : 03/10/2010
Last Update Date : 08/27/2010

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Directions to “ST. ANTHONYS ANESTHESIA PA ” Practice Location

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