Healthcare Provider Details

I. General information

NPI: 1689104796
Provider Name (Legal Business Name): JAADE ANESTHESIA MANAGEMENT LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/13/2017
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17980 DALLAS PKWY STE 100
DALLAS TX
75287-6817
US

IV. Provider business mailing address

3308 PRESTON RD STE 350
PLANO TX
75093-7471
US

V. Phone/Fax

Practice location:
  • Phone: 214-629-3576
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number State

VIII. Authorized Official

Name: BOBBY SMITH
Title or Position: OWNER/AUTH OFFICIAL
Credential:
Phone: 214-629-3576