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General NPI Number Information
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NPI Number | 1043636020
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Entity Type | Organization
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Legal Business Name | HILLCREST ANESTHESIA, PLLC
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Dates
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Enumeration Date | 03/13/2014
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Last Update Date | 03/13/2014
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Provider Practice Location Address
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Address Line | 4100 INTERNATIONAL PLZ SUITE 600
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City | FORT WORTH
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State | TX
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Zip | 76109-4820
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Country | US
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Telephone | 817-529-2658
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Fax |
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Provider Business Mailing Address
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Address Line | 12890 HILLCREST RD SUITE 203
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City | DALLAS
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State | TX
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Zip | 75230-1504
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Country | US
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Telephone | 972-573-0695
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Fax |
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Authorized Official
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Title or Position | DELEGATED OFFICIAL
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Name | PAM SIMMONS
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Credential |
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Telephone | 817-529-2658
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number |
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License Number State |
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