Healthcare Provider Details

I. General information

NPI: 1417456096
Provider Name (Legal Business Name): STAND ALONE ANESTHESIA, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/08/2018
Last Update Date: 02/09/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1701 OHIO DR
PLANO TX
75093-5208
US

IV. Provider business mailing address

PO BOX 5007
FRISCO TX
75035-0200
US

V. Phone/Fax

Practice location:
  • Phone: 214-291-3000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAP123132
License Number StateTX

VIII. Authorized Official

Name: MR. JORDAN BOND COOPER
Title or Position: CRNA
Credential: CRNA
Phone: 713-416-0218