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General NPI Number Information
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NPI Number | 1699710780
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Entity Type | Organization
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Legal Business Name | BOUTIQUE ANESTHESIA, LLC
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Dates
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Enumeration Date | 06/20/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 4702 S MCCOLL RD
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City | EDINBURG
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State | TX
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Zip | 78539-8201
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Country | US
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Telephone | 956-994-9770
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Fax |
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Provider Business Mailing Address
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Address Line | 4121 N 10TH ST UNIT 307
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City | MCALLEN
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State | TX
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Zip | 78504-3004
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Country | US
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Telephone | 410-507-8539
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Fax |
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | DR. ANN CHERI FOXX
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Credential | M.D.
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Telephone | 410-507-8539
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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 | TEMPORARY
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License Number State | TX
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