Healthcare Provider Details

I. General information

NPI: 1093283970
Provider Name (Legal Business Name): WOODLANDS ANESTHESIA ASSOCIATES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/08/2018
Last Update Date: 11/08/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 VISION PARK BLVD STE 160
SHENANDOAH TX
77384-3005
US

IV. Provider business mailing address

1A BURTON HILLS BLVD
NASHVILLE TN
37215-6187
US

V. Phone/Fax

Practice location:
  • Phone: 936-321-8910
  • Fax:
Mailing address:
  • Phone: 615-922-6102
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: ALINA LOGAN
Title or Position: VP
Credential:
Phone: 615-240-3740