Healthcare Provider Details

I. General information

NPI: 1114558475
Provider Name (Legal Business Name): HMG ANESTHESIA, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/27/2020
Last Update Date: 01/27/2020
Certification Date: 01/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

461 WESTPARK WAY
EULESS TX
76040-3957
US

IV. Provider business mailing address

PO BOX 822207
NORTH RICHLAND HILLS TX
76182-2207
US

V. Phone/Fax

Practice location:
  • Phone: 817-553-3627
  • Fax:
Mailing address:
  • Phone: 469-326-5115
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number State

VIII. Authorized Official

Name: BARRETT MAYFIELD
Title or Position: ADMINISTRATOR
Credential:
Phone: 469-326-5115