MEDICARE: TD ANESTHESIA SERVICES

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
2	207L00000X	Anesthesiology Physician

General Provider Information

NPI Number	:	1891166039
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TD ANESTHESIA SERVICES

Provider Business Mailing Address
First Line	:	3728 SHADY HILL DR
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75229-2711
Country	:	US
Telephone Number	:	817-516-8811
Fax Number	:	817-516-8444

Provider Business Practice Location Address
First Line	:	3728 SHADY HILL DR
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75229-2711
Country	:	US
Telephone Number	:	817-516-8811
Fax Number	:	817-516-8444

Authorized Official
Title or Position	:	MEMBER
Name	:	TERAN M DAVIS
Credential	:	DO
Telephone Number	:	817-516-8811

Provider Enumeration Date	:	10/14/2015
Last Update Date	:	10/14/2015

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Directions to “TD ANESTHESIA SERVICES ” Practice Location

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