Healthcare Provider Details

I. General information

NPI: 1972126209
Provider Name (Legal Business Name): NORTHSTAR ANESTHESIA OF MICHIGAN III PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/21/2020
Last Update Date: 05/25/2021
Certification Date: 05/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6225 N STATE HIGHWAY 161 STE 200
IRVING TX
75038-2241
US

IV. Provider business mailing address

6225 N STATE HIGHWAY 161 STE 200
IRVING TX
75038-2241
US

V. Phone/Fax

Practice location:
  • Phone: 214-687-0001
  • Fax: 972-518-0001
Mailing address:
  • Phone: 239-610-0775
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. BRIAN P WOODS
Title or Position: PRESIDENT, CLINICAL SERVICES
Credential: MD
Phone: 214-687-0001