Healthcare Provider Details

I. General information

NPI: 1588706485
Provider Name (Legal Business Name): INDEPENDENT ANESTHESIA OF TEXARKANA, L.L.P
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/14/2007
Last Update Date: 03/04/2020
Certification Date: 03/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2602 SAINT MICHAEL DR SUITE 301
TEXARKANA TX
75503-2387
US

IV. Provider business mailing address

2602 SAINT MICHAEL DR SUITE 301
TEXARKANA TX
75503-2387
US

V. Phone/Fax

Practice location:
  • Phone: 903-614-5258
  • Fax: 903-614-5260
Mailing address:
  • Phone: 903-614-5258
  • Fax: 903-614-5260

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State

VIII. Authorized Official

Name: HALEY C CAMPBELL
Title or Position: OFFICE MANAGER
Credential:
Phone: 903-614-5258