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General NPI Number Information
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NPI Number | 1740861558
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Entity Type | Organization
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Legal Business Name | PONDER ANESTHESIA PLLC
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Dates
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Enumeration Date | 04/15/2021
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Last Update Date | 04/15/2021
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Provider Practice Location Address
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Address Line | 2120 ANTILLEY RD
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City | ABILENE
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State | TX
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Zip | 79606-5211
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Country | US
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Telephone | 325-695-2020
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Fax |
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Provider Business Mailing Address
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Address Line | 2438 INDUSTRIAL BLVD PMB 166
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City | ABILENE
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State | TX
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Zip | 79605-7207
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Country | US
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Telephone | 325-660-5535
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JONATHAN PONDER
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Credential | CRNA
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Telephone | 325-660-5535
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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