MEDICARE: PROFESSIONAL ANESTHESIA ASSOCIATES, PC

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	:	1871738062
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PROFESSIONAL ANESTHESIA ASSOCIATES, PC

Provider Business Mailing Address
First Line	:	3411 GARTH RD # 136
Second Line	:
City	:	BAYTOWN
State	:	TX
Zip	:	77521-3851
Country	:	US
Telephone Number	:	205-370-2381
Fax Number	:

Provider Business Practice Location Address
First Line	:	3107 W COLORADO AVE # 300
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80904-2040
Country	:	US
Telephone Number	:	205-370-2381
Fax Number	:

Authorized Official
Title or Position	:	MEMBER
Name	:	JOHN CLIFFORD ALLEN
Credential	:	CRNA
Telephone Number	:	205-370-2381

Provider Enumeration Date	:	12/03/2008
Last Update Date	:	02/18/2009

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