Healthcare Provider Details
I. General information
NPI: 1124201827
Provider Name (Legal Business Name): APEX ANESTHESIA CONSULTANTS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:
II. Dates (important events)
Enumeration Date: 12/17/2007
Last Update Date: 12/17/2007
Certification Date:
Deactivation Date:
Reactivation Date:
III. Provider practice location address
4200 S HULEN ST SUITE 425
FORT WORTH TX
76109-4914
US
IV. Provider business mailing address
4200 S HULEN ST SUITE 425
FORT WORTH TX
76109-4914
US
V. Phone/Fax
- Phone: 817-731-2875
- Fax:
- Phone: 817-731-2875
- Fax:
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 207L00000X |
| Taxonomy | Anesthesiology Physician |
| License Number | |
| License Number State | |
VIII. Authorized Official
Name:
RONALD
S
ANDERSON
Title or Position: MGR
Credential: M.D.
Phone: 817-731-2875