Healthcare Provider Details

I. General information

NPI: 1811782824
Provider Name (Legal Business Name): GATES ANESTHESIA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/10/2025
Last Update Date: 04/10/2025
Certification Date: 04/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3211 SUGAR HILL RD
TEXARKANA AR
71854-9219
US

IV. Provider business mailing address

PO BOX 55990
LITTLE ROCK AR
72215-5990
US

V. Phone/Fax

Practice location:
  • Phone: 870-772-4440
  • Fax:
Mailing address:
  • Phone: 501-227-0700
  • Fax: 501-227-0744

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number State

VIII. Authorized Official

Name: JUSTIN GATES
Title or Position: OWNER
Credential: CRNA
Phone: 870-866-8646