MEDICARE: SUMMIT ANESTHESIA GROUP, 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	207L00000X	Anesthesiology Physician

General Provider Information

NPI Number	:	1497579288
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUMMIT ANESTHESIA GROUP, PLLC

Provider Business Mailing Address
First Line	:	959 SUNLAND PARK DR STE 200
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79922-1323
Country	:	US
Telephone Number	:	915-201-3033
Fax Number	:	915-542-0156

Provider Business Practice Location Address
First Line	:	959 SUNLAND PARK DR STE 200
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79922-1323
Country	:	US
Telephone Number	:	915-201-3033
Fax Number	:	915-542-0156

Authorized Official
Title or Position	:	OWNER
Name	:	DR. MARK GALLARDO
Credential	:	MD
Telephone Number	:	915-201-3033

Provider Enumeration Date	:	11/08/2024
Last Update Date	:	04/17/2026

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