=====================================================
General NPI Number Information
=====================================================
NPI Number | 1639122211
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ALPHA ANESTHESIA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/18/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4275 LITTLE RD
-----------------------------------------------------
City | ARLINGTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76016-5618
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 817-516-8811
-----------------------------------------------------
Fax | 817-516-8444
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 975
-----------------------------------------------------
City | KEENE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76059-0975
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 817-516-8811
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | ERNEST ALVIN AQUI
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 817-800-9724
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207L00000X
-----------------------------------------------------
Taxonomy Name | Anesthesiology Physician
-----------------------------------------------------
License Number | J5687
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------