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NPI Code Detail

MEDICARE: TRIDENT ANESTHESIA LLC

MEDICARE: TRIDENT 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
1367500000XCertified Registered Nurse Anesthetist802560511TX

General Provider Information

NPI Number : 1699218149
Entity Type Code : Organization
Provider Name (Legal Business Name) : TRIDENT ANESTHESIA LLC
Provider Business Mailing Address
First Line : 400 10TH ST E
Second Line :
City : WACONIA
State : MN
Zip : 55387-4552
Country : US
Telephone Number : 682-297-6708
Fax Number : 952-442-3620
Provider Business Practice Location Address
First Line : 2001 COOPER ST
Second Line :
City : FORT WORTH
State : TX
Zip : 76104-2529
Country : US
Telephone Number : 682-800-1099
Fax Number :
Authorized Official
Title or Position : MANAGER
Name : JOHN ADAM CHAUCER
Credential : CRNA
Telephone Number : 817-727-0985
Provider Enumeration Date : 11/30/2016
Last Update Date : 09/02/2022

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Directions to “TRIDENT ANESTHESIA LLC ” Practice Location

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