Healthcare Provider Details

I. General information

NPI: 1740861558
Provider Name (Legal Business Name): PONDER ANESTHESIA PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/15/2021
Last Update Date: 04/15/2021
Certification Date: 04/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2120 ANTILLEY RD
ABILENE TX
79606-5211
US

IV. Provider business mailing address

2438 INDUSTRIAL BLVD PMB 166
ABILENE TX
79605-7207
US

V. Phone/Fax

Practice location:
  • Phone: 325-695-2020
  • Fax:
Mailing address:
  • Phone: 325-660-5535
  • Fax:

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: JONATHAN PONDER
Title or Position: OWNER
Credential: CRNA
Phone: 325-660-5535