Healthcare Provider Details

I. General information

NPI: 1639824246
Provider Name (Legal Business Name): MORNINGSTAR ANESTHESIA PROFESSIONALS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/14/2022
Last Update Date: 04/23/2024
Certification Date: 04/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 W PLEASANT RUN RD
LANCASTER TX
75146-1114
US

IV. Provider business mailing address

PO BOX 1889
MUNCIE IN
47308-1889
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: JASON MORNINGSTAR
Title or Position: OWNER/AUTH OFFICIAL
Credential:
Phone: 214-579-5794