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General NPI Number Information
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NPI Number | 1548788995
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Entity Type | Organization
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Legal Business Name | CHAMPION ANESTHESIA PLLC
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Dates
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Enumeration Date | 09/06/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 17070 RED OAK DR STE 503
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City | HOUSTON
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State | TX
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Zip | 77090-2617
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Country | US
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Telephone | 281-444-2399
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Fax |
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Provider Business Mailing Address
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Address Line | 17070 RED OAK DR STE 503
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City | HOUSTON
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State | TX
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Zip | 77090-2617
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Country | US
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Telephone | 281-444-2399
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Fax |
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | GRETCHEN DAULTON
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Credential |
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Telephone | 281-444-2399
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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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