Healthcare Provider Details

I. General information

NPI: 1194967422
Provider Name (Legal Business Name): GREATER HOUSTON ANESTHESIOLOGY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/01/2009
Last Update Date: 04/01/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

650 NE 160TH ST
NORTH MIAMI BEACH FL
33162-3654
US

IV. Provider business mailing address

650 NE 160TH ST
NORTH MIAMI BEACH FL
33162-3654
US

V. Phone/Fax

Practice location:
  • Phone: 786-554-2253
  • Fax:
Mailing address:
  • Phone: 786-554-2253
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License Number367H00000X
License Number StateFL

VIII. Authorized Official

Name: HUY TROUNH VO
Title or Position: ANESTHESIOLOGIST ASSISTANT
Credential:
Phone: 786-554-2253