MEDICARE: NORTHSTAR 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
1	367500000X	Certified Registered Nurse Anesthetist
2	207L00000X	Anesthesiology Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1912978610
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTHSTAR ANESTHESIA, PA

Provider Business Mailing Address
First Line	:	PO BOX 650252
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75265-0252
Country	:	US
Telephone Number	:	239-610-0775
Fax Number	:

Provider Business Practice Location Address
First Line	:	2000 E LAMAR BLVD
Second Line	:	SUITE 400
City	:	ARLINGTON
State	:	TX
Zip	:	76006-7346
Country	:	US
Telephone Number	:	817-861-3994
Fax Number	:	682-227-6869

Authorized Official
Title or Position	:	CLIENT LIAISON
Name	:	MRS. BECKY PETROSS
Credential	:
Telephone Number	:	817-334-0530

Provider Enumeration Date	:	01/30/2006
Last Update Date	:	05/25/2021

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Directions to “NORTHSTAR ANESTHESIA, PA ” Practice Location

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