MEDICARE: VIRTUE ANESTHESIA PLLC

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	367500000X	Certified Registered Nurse Anesthetist

General Provider Information

NPI Number	:	1255877551
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VIRTUE ANESTHESIA PLLC

Provider Business Mailing Address
First Line	:	119 CLUB HOUSE DR
Second Line	:
City	:	WEATHERFORD
State	:	TX
Zip	:	76087-4001
Country	:	US
Telephone Number	:	214-287-2886
Fax Number	:	817-900-2684

Provider Business Practice Location Address
First Line	:	209 SAINT LOUIS AVE
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76104-1231
Country	:	US
Telephone Number	:	214-287-2886
Fax Number	:	817-900-2684

Authorized Official
Title or Position	:	CRNA
Name	:	NICHOLAS ANTHONY BAIRD
Credential	:
Telephone Number	:	214-287-2886

Provider Enumeration Date	:	01/10/2017
Last Update Date	:	09/10/2019

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