Provider Demographics
NPI:1063622199
Name:ACCESS ANESTHESIA, LLC
Entity type:Organization
Organization Name:ACCESS ANESTHESIA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:TYDLASKA
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:817-496-0749
Mailing Address - Street 1:1832 CROOKED LN
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76112-4509
Mailing Address - Country:US
Mailing Address - Phone:877-614-1322
Mailing Address - Fax:817-496-0424
Practice Address - Street 1:1832 CROOKED LN
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76112-4509
Practice Address - Country:US
Practice Address - Phone:877-614-1322
Practice Address - Fax:817-496-0424
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-24
Last Update Date:2014-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty