Healthcare Provider Details

I. General information

NPI: 1699022202
Provider Name (Legal Business Name): ANGLETON ANESTHESIA MANAGEMENT SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/14/2012
Last Update Date: 08/14/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

146 E HOSPITAL DR
ANGLETON TX
77515-4169
US

IV. Provider business mailing address

1200 E COLLINS BLVD SUITE 106
RICHARDSON TX
75081-2457
US

V. Phone/Fax

Practice location:
  • Phone: 979-849-8240
  • Fax: 903-374-4711
Mailing address:
  • Phone: 214-254-4672
  • Fax: 903-374-4711

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. TERRANCE BRANDON JOHNSON
Title or Position: CEO/PRESIDENT
Credential:
Phone: 214-254-4672