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General NPI Number Information
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NPI Number | 1588931174
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Entity Type | Organization
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Legal Business Name | ENDO SEDATION LLC
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Dates
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Enumeration Date | 11/26/2011
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Last Update Date | 10/11/2021
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Provider Practice Location Address
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Address Line | 180 BEAR CREEK PKWY
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City | KELLER
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State | TX
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Zip | 76248-2500
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Country | US
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Telephone | 972-763-3893
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Fax | 972-692-6745
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Provider Business Mailing Address
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Address Line | 550 RESERVE ST STE 560
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City | SOUTHLAKE
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State | TX
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Zip | 76092-1607
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Country | US
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Telephone | 817-402-7526
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Fax |
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Authorized Official
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Title or Position | ANESTHESIA SUPPORT SERVICES COORD
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Name | BRANDI WHEELER
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Credential |
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Telephone | 817-402-7526
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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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Taxonomy #2
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number |
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License Number State |
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