Healthcare Provider Details

I. General information

NPI: 1871140889
Provider Name (Legal Business Name): SATELLITE ANESTHESIA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/23/2019
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1304 BELLONA AVE
LUTHERVILLE MD
21093-5425
US

IV. Provider business mailing address

3301 S 14TH ST STE 16180
ABILENE TX
79605-5015
US

V. Phone/Fax

Practice location:
  • Phone: 410-616-3000
  • Fax:
Mailing address:
  • Phone: 325-675-6466
  • Fax: 325-692-6030

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: POPPY WALKER
Title or Position: PRACTICE ADMINISTRATOR
Credential: MBA
Phone: 325-675-6466