Healthcare Provider Details

I. General information

NPI: 1619123718
Provider Name (Legal Business Name): CEDAR HILL AVENUE ANAESTHESIA ASSOCIATION, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/08/2008
Last Update Date: 01/08/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1419 CEDAR HILL AVE
DALLAS TX
75208-2406
US

IV. Provider business mailing address

1419 CEDAR HILL AVE
DALLAS TX
75208-2406
US

V. Phone/Fax

Practice location:
  • Phone: 214-943-4244
  • Fax: 214-943-1832
Mailing address:
  • Phone: 214-943-4244
  • Fax: 214-943-1832

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License NumberC6355
License Number StateTX

VIII. Authorized Official

Name: WAYNE LAMONT HELLMAN
Title or Position: OWNER/PRESIDENT
Credential: M.D.
Phone: 214-943-4244