MEDICARE: TRICITY ANESTHESIA ASSOCIATES 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	207LP2900X	Pain Medicine (Anesthesiology) Physician

General Provider Information

NPI Number	:	1831595990
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TRICITY ANESTHESIA ASSOCIATES PLLC

Provider Business Mailing Address
First Line	:	PO BOX 2749
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78299-2749
Country	:	US
Telephone Number	:	210-268-0129
Fax Number	:	210-497-3593

Provider Business Practice Location Address
First Line	:	110 STONE OAK LOOP
Second Line	:	SUITE 103
City	:	SAN ANTONIO
State	:	TX
Zip	:	78258-3510
Country	:	US
Telephone Number	:	210-268-0129
Fax Number	:	210-497-3593

Authorized Official
Title or Position	:	OWNER
Name	:	URFAN DAR
Credential	:
Telephone Number	:	210-268-0129

Provider Enumeration Date	:	11/17/2014
Last Update Date	:	11/17/2014

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