Healthcare Provider Details

I. General information

NPI: 1497297535
Provider Name (Legal Business Name): COMFORT ANESTHESIA PLLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/07/2016
Last Update Date: 03/08/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5757 WARREN PKWY STE 110
FRISCO TX
75034-4273
US

IV. Provider business mailing address

PO BOX 112
MUNCIE IN
47308-0112
US

V. Phone/Fax

Practice location:
  • Phone: 214-317-5202
  • Fax:
Mailing address:
  • Phone: 765-284-0493
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number State

VIII. Authorized Official

Name: JERRY LEWIS
Title or Position: OWNER/PHYSICIAN
Credential:
Phone: 214-317-5202