MEDICARE: BARDEN MEDICAL MANAGEMENT, 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
1	207L00000X	Anesthesiology Physician
2	367500000X	Certified Registered Nurse Anesthetist

General Provider Information

NPI Number	:	1891152260
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BARDEN MEDICAL MANAGEMENT, LLC

Provider Business Mailing Address
First Line	:	1907 CYPRESS CREEK RD
Second Line	:	SUITE #108
City	:	CEDAR PARK
State	:	TX
Zip	:	78613-4150
Country	:	US
Telephone Number	:	512-374-1876
Fax Number	:

Provider Business Practice Location Address
First Line	:	1907 CYPRESS CREEK RD
Second Line	:	SUITE #108
City	:	CEDAR PARK
State	:	TX
Zip	:	78613-4150
Country	:	US
Telephone Number	:	512-374-1876
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	BARBARA JAMES
Credential	:
Telephone Number	:	512-374-1876

Provider Enumeration Date	:	01/15/2016
Last Update Date	:	04/10/2017

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