=====================================================
General NPI Number Information
=====================================================
NPI Number | 1578635892
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TEXAS HILL COUNTRY ANESTHESIA PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/14/2006
-----------------------------------------------------
Last Update Date | 02/14/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7900 FM 1826 SETON SOUTHWEST
-----------------------------------------------------
City | AUSTIN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78737
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 512-324-9808
-----------------------------------------------------
Fax | 512-324-9086
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 141456
-----------------------------------------------------
City | AUSTIN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78714
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 512-225-6345
-----------------------------------------------------
Fax | 512-692-5205
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMIN ASST
-----------------------------------------------------
Name | SUSAN R CHAMPAGNE-MILLER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 512-225-6345
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207L00000X
-----------------------------------------------------
Taxonomy Name | Anesthesiology Physician
-----------------------------------------------------
License Number | L1048
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207L00000X
-----------------------------------------------------
Taxonomy Name | Anesthesiology Physician
-----------------------------------------------------
License Number | 24332
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------