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General NPI Number Information
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NPI Number | 1649676024
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Entity Type | Organization
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Legal Business Name | CHAMPION ANESTHESIA CONSULTANTS, PLLC
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Dates
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Enumeration Date | 11/12/2014
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Last Update Date | 04/24/2023
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Provider Practice Location Address
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Address Line | 421 E STATE HIGHWAY 114
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City | SOUTHLAKE
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State | TX
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Zip | 76092-3635
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Country | US
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Telephone | 817-865-4516
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Fax |
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Provider Business Mailing Address
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Address Line | 7167 COLLEYVILLE BLVD STE 104
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City | COLLEYVILLE
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State | TX
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Zip | 76034-8002
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Country | US
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Telephone | 817-657-2030
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Fax |
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Authorized Official
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Title or Position | OWNER/PHYSICIAN
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Name | DR. TIMOTHY TYE
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Credential | DO
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Telephone | 817-657-2030
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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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