Healthcare Provider Details

I. General information

NPI: 1578513768
Provider Name (Legal Business Name): ANESTHESIA CONSULTANTS OF DALLAS, LLP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2006
Last Update Date: 09/28/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

221 W COLORADO BLVD PAVILION II SUITE 845
DALLAS TX
75208-2363
US

IV. Provider business mailing address

PO BOX 911589
DALLAS TX
75391-1589
US

V. Phone/Fax

Practice location:
  • Phone: 214-946-1133
  • Fax: 214-946-3048
Mailing address:
  • Phone: 214-522-0210
  • Fax: 214-522-0474

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. RICHARD JAY WINGO
Title or Position: MANAGING PARTNER
Credential: M.D.
Phone: 214-946-1133