Healthcare Provider Details

I. General information

NPI: 1255370698
Provider Name (Legal Business Name): HB ANESTHESIOLOGY GROUP PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2006
Last Update Date: 09/13/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 S JOHN REDDITT DR
LUFKIN TX
75904-3120
US

IV. Provider business mailing address

PO BOX 155808
LUFKIN TX
75915-5808
US

V. Phone/Fax

Practice location:
  • Phone: 936-639-3036
  • Fax:
Mailing address:
  • Phone: 936-639-3036
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State

VIII. Authorized Official

Name: KATHLEEN KONDAS
Title or Position: OFFICER
Credential:
Phone: 954-838-2371