Healthcare Provider Details

I. General information

NPI: 1306123195
Provider Name (Legal Business Name): SURGICAL ANESTHESIA MANAGEMENT OF TEXAS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/08/2011
Last Update Date: 04/05/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1815 NORTH STANTON
EL PASO TX
79902-3511
US

IV. Provider business mailing address

PO BOX #204304
DALLAS TX
75320-4304
US

V. Phone/Fax

Practice location:
  • Phone: 855-706-5542
  • Fax: 706-650-1034
Mailing address:
  • Phone: 800-855-7065
  • Fax: 706-650-1034

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: MR. ANDREW R. RIBAUDO
Title or Position: PRESIDENT
Credential:
Phone: 404-446-1417