Healthcare Provider Details

I. General information

NPI: 1164691200
Provider Name (Legal Business Name): BDH ANESTHESIA ASSOCIATES PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/22/2008
Last Update Date: 02/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4570 N EXPRESSWAY
BROWNSVILLE TX
78526
US

IV. Provider business mailing address

PO BOX 1246
POPLAR BLUFF MO
63902-1246
US

V. Phone/Fax

Practice location:
  • Phone: 956-554-2012
  • Fax:
Mailing address:
  • Phone: 573-785-3861
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State

VIII. Authorized Official

Name: LISA MASICA
Title or Position: SECRETARY/MEMBER
Credential: CRNA
Phone: 956-358-4050