Provider Demographics
NPI:1063538643
Name:BAYOU CITY ANESTHESIA GROUP
Entity type:Organization
Organization Name:BAYOU CITY ANESTHESIA GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:M
Authorized Official - Last Name:KEEPERS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:713-943-7246
Mailing Address - Street 1:308 W PARKWOOD AVE
Mailing Address - Street 2:#106
Mailing Address - City:FRIENDSWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:77546-5478
Mailing Address - Country:US
Mailing Address - Phone:713-943-7246
Mailing Address - Fax:713-943-2040
Practice Address - Street 1:12950 EAST FWY
Practice Address - Street 2:SUITE #100
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77015-5710
Practice Address - Country:US
Practice Address - Phone:713-943-7246
Practice Address - Fax:713-943-2040
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-22
Last Update Date:2015-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX177333501Medicaid
TX00756YMedicare ID - Type UnspecifiedMEDICARE