Healthcare Provider Details

I. General information

NPI: 1396295614
Provider Name (Legal Business Name): HEARTBEAT ANESTHESIA PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/11/2016
Last Update Date: 10/12/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5757 WARREN PKWY SUITE 110
FRISCO TX
75034-4274
US

IV. Provider business mailing address

PO BOX 112
MUNCIE IN
47308-0112
US

V. Phone/Fax

Practice location:
  • Phone: 214-618-9622
  • Fax:
Mailing address:
  • Phone: 765-284-0493
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: JERRY W LEWIS
Title or Position: OWNER/PHYSICIAN
Credential: MD
Phone: 214-618-9622