Healthcare Provider Details

I. General information

NPI: 1922546159
Provider Name (Legal Business Name): STANDARD ANESTHESIA, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/08/2017
Last Update Date: 02/08/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10700 MCPHERSON RD
LAREDO TX
78045-6268
US

IV. Provider business mailing address

13932 INTERSTATE 10 E
CONVERSE TX
78109-3136
US

V. Phone/Fax

Practice location:
  • Phone: 210-413-3642
  • Fax: 888-681-5805
Mailing address:
  • Phone: 210-413-3642
  • Fax: 888-681-5805

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberL2331
License Number StateTX

VIII. Authorized Official

Name: DR. JOHN HUNTSINGER
Title or Position: ORGANIZER
Credential: MD
Phone: 210-413-3642