Healthcare Provider Details

I. General information

NPI: 1255720728
Provider Name (Legal Business Name): DDCA ANESTHESIA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/21/2015
Last Update Date: 01/21/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6833 PLUM CREEK DR
AMARILLO TX
79124-1602
US

IV. Provider business mailing address

401 COMMERCE ST SUITE 600
NASHVILLE TN
37219-2446
US

V. Phone/Fax

Practice location:
  • Phone: 806-467-9820
  • Fax:
Mailing address:
  • Phone: 615-345-6905
  • 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: MR. JEFFREY R FISHER
Title or Position: CFO
Credential:
Phone: 615-345-6905