MEDICARE: NORTHWOODS ANESTHESIA, P.A.

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	424871	TX
2	367500000X	Certified Registered Nurse Anesthetist	021454	TX
3	207L00000X	Anesthesiology Physician	J7319	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	CK3380	OTHER	TX	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MDJ7319	OTHER	TX	TEXAS WORKER'S COMP
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	0031HZ	OTHER	TX	BLUE CROSS/BLUE SHIELD

General Provider Information

NPI Number	:	1861401549
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTHWOODS ANESTHESIA, P.A.

Provider Business Mailing Address
First Line	:	13114 FM 1960 W
Second Line	:	SUITE 118 A
City	:	HOUSTON
State	:	TX
Zip	:	77065-4290
Country	:	US
Telephone Number	:	936-523-0300
Fax Number	:	713-559-9109

Provider Business Practice Location Address
First Line	:	13114 FM 1960 W
Second Line	:	SUITE 118 A
City	:	HOUSTON
State	:	TX
Zip	:	77065-4290
Country	:	US
Telephone Number	:	936-523-0300
Fax Number	:	713-559-9109

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JAMES SCOTT COLEMAN
Credential	:	M.D.
Telephone Number	:	936-523-0300

Provider Enumeration Date	:	08/05/2006
Last Update Date	:	10/21/2010

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Directions to “NORTHWOODS ANESTHESIA, P.A. ” Practice Location

Language	Start Address	Practice Location

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