MEDICARE: PROVIDENCE ANESTHESIA SERVICES 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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1730253048	OTHER		NPI

General Provider Information

NPI Number	:	1790377133
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PROVIDENCE ANESTHESIA SERVICES PLLC

Provider Business Mailing Address
First Line	:	7520 MALABAR LN
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75230-2412
Country	:	US
Telephone Number	:	214-738-3441
Fax Number	:

Provider Business Practice Location Address
First Line	:	7520 MALABAR LN
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75230-2412
Country	:	US
Telephone Number	:	214-738-3441
Fax Number	:	888-746-2645

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. CAROLINE HAHN
Credential	:	MD
Telephone Number	:	214-738-3441

Provider Enumeration Date	:	02/08/2021
Last Update Date	:	02/08/2021

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