Healthcare Provider Details

I. General information

NPI: 1093140022
Provider Name (Legal Business Name): HALE COUNTY ANESTHESIA ASSOCIATES, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/10/2013
Last Update Date: 10/18/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2601 DIMMITT RD
PLAINVIEW TX
79072-1833
US

IV. Provider business mailing address

255 W MICHIGAN AVE PO BOX 1123
JACKSON MI
49201-2218
US

V. Phone/Fax

Practice location:
  • Phone: 806-291-3304
  • Fax:
Mailing address:
  • Phone: 800-242-1131
  • Fax: 517-787-4146

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 Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL HICKS
Title or Position: AUTHORIZED REPRESENTATIVE
Credential: MD
Phone: 972-715-5044