MEDICARE: MID TEX ANESTHESIA ASSOCIATES, PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207L00000X	Anesthesiology Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1174612857
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MID TEX ANESTHESIA ASSOCIATES, PA

Provider Business Mailing Address
First Line	:	405 LONDONDERRY DR STE 105
Second Line	:
City	:	WACO
State	:	TX
Zip	:	76712-7920
Country	:	US
Telephone Number	:	254-776-0266
Fax Number	:	254-776-2511

Provider Business Practice Location Address
First Line	:	405 LONDONDERRY DR
Second Line	:	SUITE 105
City	:	WACO
State	:	TX
Zip	:	76712-7920
Country	:	US
Telephone Number	:	254-776-0266
Fax Number	:	254-776-2511

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	GAY LYNN KENT
Credential	:
Telephone Number	:	254-776-0266

Provider Enumeration Date	:	10/12/2006
Last Update Date	:	05/19/2026

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