Healthcare Provider Details

I. General information

NPI: 1477828028
Provider Name (Legal Business Name): PSA ANESTHESIA PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/15/2012
Last Update Date: 09/04/2024
Certification Date: 09/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4100 DUVAL RD STE 100
AUSTIN TX
78759-3550
US

IV. Provider business mailing address

PO BOX 208379
DALLAS TX
75320-8379
US

V. Phone/Fax

Practice location:
  • Phone: 855-876-7246
  • Fax: 855-277-5070
Mailing address:
  • Phone: 855-876-7246
  • Fax: 844-364-8678

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: ANGELA OPALAK
Title or Position: VICE PRESIDENT OF RCM
Credential:
Phone: 512-485-7200