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NPI Code Detail

MEDICARE: ANESTHESIA AND INTENSIVE CARE

MEDICARE: ANESTHESIA AND INTENSIVE CARE
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
1207L00000XAnesthesiology Physician

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1366589590
Entity Type Code : Organization
Provider Name (Legal Business Name) : ANESTHESIA AND INTENSIVE CARE
Provider Business Mailing Address
First Line : 51 DOGWOOD LAKE DRIVE
Second Line :
City : TEXARKANA
State : TX
Zip : 75503
Country : US
Telephone Number : 903-701-0156
Fax Number : 903-793-7996
Provider Business Practice Location Address
First Line : 1000 PINE STREET
Second Line :
City : TEXARKANA
State : TX
Zip : 75501-5100
Country : US
Telephone Number : 903-701-0156
Fax Number : 903-793-7996
Authorized Official
Title or Position : ANESTHESIOLOGIST
Name : JOHNNY M COLLEY
Credential : MD
Telephone Number : 903-701-0156
Provider Enumeration Date : 01/30/2007
Last Update Date : 10/25/2013

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Directions to “ANESTHESIA AND INTENSIVE CARE ” Practice Location

Language Start Address Practice Location
These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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