=====================================================
General NPI Number Information
=====================================================
NPI Number | 1568356541
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | UNDERWAY ANESTHESIA SERVICES, PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/05/2025
-----------------------------------------------------
Last Update Date | 07/02/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 830 CANYON TRL
-----------------------------------------------------
City | LAKEHILLS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78063-2318
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 210-386-8224
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 63203
-----------------------------------------------------
City | PIPE CREEK
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78063-3203
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 210-386-8224
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CREDENTIALING MANAGER
-----------------------------------------------------
Name | LIZ HUSSEY
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 469-437-3564
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207L00000X
-----------------------------------------------------
Taxonomy Name | Anesthesiology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------