MEDICARE: MEDICAL CENTER 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	:	1265418222
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEDICAL CENTER ANESTHESIA ASSOCIATES PA

Provider Business Mailing Address
First Line	:	2424 W HOLCOMBE BLVD
Second Line	:	STE 205
City	:	HOUSTON
State	:	TX
Zip	:	77030-1934
Country	:	US
Telephone Number	:	713-790-9412
Fax Number	:	713-790-9738

Provider Business Practice Location Address
First Line	:	2424 W HOLCOMBE BLVD
Second Line	:	STE 205
City	:	HOUSTON
State	:	TX
Zip	:	77030-1934
Country	:	US
Telephone Number	:	713-790-9412
Fax Number	:	713-790-9738

Authorized Official
Title or Position	:	OPERATIONS MANAGER
Name	:	JENNIFER L TODD
Credential	:
Telephone Number	:	713-790-9412

Provider Enumeration Date	:	12/21/2005
Last Update Date	:	07/11/2014

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