=====================================================
General NPI Number Information
=====================================================
NPI Number | 1154832053
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | INF ANESTHESIA, PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/18/2017
-----------------------------------------------------
Last Update Date | 10/18/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5706 E MOCKINGBIRD LN STE 115 #404
-----------------------------------------------------
City | DALLAS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75206-5461
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 972-370-5746
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5706 E MOCKINGBIRD LN STE 115 #404
-----------------------------------------------------
City | DALLAS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75206-5461
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 972-370-5746
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MDMS NPI COMPLIANCE OFFICER
-----------------------------------------------------
Name | LIZETTE MORIN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 210-598-2801
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207L00000X
-----------------------------------------------------
Taxonomy Name | Anesthesiology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------