Healthcare Provider Details

I. General information

NPI: 1902253644
Provider Name (Legal Business Name): TEAMWORXANESTHESIA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2016
Last Update Date: 05/23/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5734 SPOHN DR
CORPUS CHRISTI TX
78414-4116
US

IV. Provider business mailing address

15926 EL SOCCORRO LOOP
CORPUS CHRISTI TX
78418-6604
US

V. Phone/Fax

Practice location:
  • Phone: 361-653-1125
  • Fax:
Mailing address:
  • Phone: 361-425-5290
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number726953
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number726953
License Number StateTX

VIII. Authorized Official

Name: TED HOLMES
Title or Position: MANAGER
Credential: C.R.N.A
Phone: 361-425-5290