=====================================================
General NPI Number Information
=====================================================
NPI Number | 1831442425
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NORTHWEST ANESTHESIOLOGY & PAIN SERVICE PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/19/2012
-----------------------------------------------------
Last Update Date | 09/19/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5225 KATY FWY STE 105A
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77007-2292
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-487-3313
-----------------------------------------------------
Fax | 713-862-7405
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1620 W. NORTHWEST HWY STE. 100
-----------------------------------------------------
City | GRAPEVINE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76051
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 817-572-0009
-----------------------------------------------------
Fax | 817-720-1039
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MGR. THIRD PARTY ADMIN & LICEN
-----------------------------------------------------
Name | TAMMIE MISKIMINS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 817-572-0009
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 333600000X
-----------------------------------------------------
Taxonomy Name | Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number | 28227
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------