Healthcare Provider Details

I. General information

NPI: 1104803089
Provider Name (Legal Business Name): WAXAHACHIE ANESTHESIA CONSULTANT SERVICES PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/30/2005
Last Update Date: 09/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 N HIGHWAY 77 SUITE 160 PMB #224
WAXAHACHIE TX
75165-1884
US

IV. Provider business mailing address

800 N HIGHWAY 77 SUITE 160 PMB 224
WAXAHACHIE TX
75165-1884
US

V. Phone/Fax

Practice location:
  • Phone: 972-937-7240
  • Fax:
Mailing address:
  • Phone: 972-937-7240
  • Fax: 972-937-4255

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State

VIII. Authorized Official

Name: MS. PATTY WEATHERFORD
Title or Position: PRACTICE ADMINISTRATOR
Credential: CPC
Phone: 972-937-7240