Healthcare Provider Details

I. General information

NPI: 1871802710
Provider Name (Legal Business Name): FREDERICKSBURG ANESTHESIA CONSULTANTS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/27/2010
Last Update Date: 09/13/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

132 E HOSPITAL DR
ANGLETON TX
77515-4112
US

IV. Provider business mailing address

PO BOX 650802
DALLAS TX
75265-0802
US

V. Phone/Fax

Practice location:
  • Phone: 972-715-5000
  • Fax:
Mailing address:
  • Phone: 972-715-5000
  • 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 Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL RAY HICKS
Title or Position: PRESIDENT/ CMO
Credential: DR.
Phone: 954-838-2371