Healthcare Provider Details

I. General information

NPI: 1912245440
Provider Name (Legal Business Name): SENTINEL ANESTHESIA, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/17/2013
Last Update Date: 01/17/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16926 SOUTHWEST FREEWAY
SUGARLAND TX
77479
US

IV. Provider business mailing address

5118 YARWELL DR
HOUSTON TX
77096-5314
US

V. Phone/Fax

Practice location:
  • Phone: 713-412-1200
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberK8775
License Number StateTX

VIII. Authorized Official

Name: DR. TODD KELLY
Title or Position: OWNER
Credential: M.D.
Phone: 713-412-1200