Healthcare Provider Details

I. General information

NPI: 1710699517
Provider Name (Legal Business Name): GALAXY ANESTHESIA PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/23/2022
Last Update Date: 12/23/2022
Certification Date: 12/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11500 STATE HIGHWAY 121 STE 810
FRISCO TX
75035-9347
US

IV. Provider business mailing address

PO BOX 1327
FRISCO TX
75034-0023
US

V. Phone/Fax

Practice location:
  • Phone: 214-618-9613
  • Fax:
Mailing address:
  • Phone: 214-618-9622
  • 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: JOSHUA LEWIS
Title or Position: MANAGER
Credential:
Phone: 214-618-9613