MEDICARE: AMIEBO ANESTHESIA 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	207L00000X	Anesthesiology Physician

General Provider Information

NPI Number	:	1972231215
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AMIEBO ANESTHESIA PLLC

Provider Business Mailing Address
First Line	:	25500 TWO CREEKS APT 1203
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78255-2501
Country	:	US
Telephone Number	:	210-844-5877
Fax Number	:

Provider Business Practice Location Address
First Line	:	25500 TWO CREEKS APT 1203
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78255-2501
Country	:	US
Telephone Number	:	210-844-5877
Fax Number	:

Authorized Official
Title or Position	:	BUSINESS MANAGER
Name	:	AMIE BLAIR
Credential	:
Telephone Number	:	210-844-5877

Provider Enumeration Date	:	08/14/2022
Last Update Date	:	09/02/2022

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