MEDICARE: PEC ANESTHESIA LLC

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	:	1528305208
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PEC ANESTHESIA LLC

Provider Business Mailing Address
First Line	:	14201 DALLAS PKWY
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75254-2916
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1029 MAKOLU ST
Second Line	:	STE H
City	:	PEARL CITY
State	:	HI
Zip	:	96782-2890
Country	:	US
Telephone Number	:	808-456-6420
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT BOARD OF MANAGERS
Name	:	MR. DAVID W HOLST
Credential	:
Telephone Number	:	615-345-6900

Provider Enumeration Date	:	01/15/2013
Last Update Date	:	03/26/2026

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Directions to “PEC ANESTHESIA LLC ” Practice Location

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