=====================================================
General NPI Number Information
=====================================================
NPI Number | 1467865600
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RELIANCE ANESTHESIA GROUP, PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/05/2014
-----------------------------------------------------
Last Update Date | 06/05/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 729 W BEDFORD EULESS RD SUITE 105
-----------------------------------------------------
City | HURST
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76053-3939
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 817-516-8811
-----------------------------------------------------
Fax | 817-516-8444
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 729 W BEDFORD EULESS RD SUITE 105
-----------------------------------------------------
City | HURST
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76053-3939
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 817-516-8811
-----------------------------------------------------
Fax | 817-516-8444
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR
-----------------------------------------------------
Name | MR. BART STEELE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 817-366-8555
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207LP2900X
-----------------------------------------------------
Taxonomy Name | Pain Medicine (Anesthesiology) Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207L00000X
-----------------------------------------------------
Taxonomy Name | Anesthesiology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------