Healthcare Provider Details

I. General information

NPI: 1689056988
Provider Name (Legal Business Name): EAGLE PLUME ANESTHESIA PROVIDERS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/23/2015
Last Update Date: 06/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3901 S 7TH ST
TERRE HAUTE IN
47802-5709
US

IV. Provider business mailing address

13737 NOEL RD STE1600
DALLAS TX
75240-1331
US

V. Phone/Fax

Practice location:
  • Phone: 469-401-2386
  • Fax:
Mailing address:
  • Phone: 469-401-2386
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number State

VIII. Authorized Official

Name: EDDIE STONE
Title or Position: PRESIDENT
Credential: MD
Phone: 469-401-2386