Provider Demographics
NPI:1104803089
Name:WAXAHACHIE ANESTHESIA CONSULTANT SERVICES PA
Entity type:Organization
Organization Name:WAXAHACHIE ANESTHESIA CONSULTANT SERVICES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:PATTY
Authorized Official - Middle Name:
Authorized Official - Last Name:WEATHERFORD
Authorized Official - Suffix:
Authorized Official - Credentials:CPC
Authorized Official - Phone:972-937-7240
Mailing Address - Street 1:800 N HIGHWAY 77
Mailing Address - Street 2:SUITE 160 PMB 224
Mailing Address - City:WAXAHACHIE
Mailing Address - State:TX
Mailing Address - Zip Code:75165-1884
Mailing Address - Country:US
Mailing Address - Phone:972-937-7240
Mailing Address - Fax:972-937-4255
Practice Address - Street 1:800 N HIGHWAY 77
Practice Address - Street 2:SUITE 160 PMB #224
Practice Address - City:WAXAHACHIE
Practice Address - State:TX
Practice Address - Zip Code:75165-1884
Practice Address - Country:US
Practice Address - Phone:972-937-7240
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-30
Last Update Date:2008-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
No367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX173162202Medicaid
TX00587XMedicare ID - Type Unspecified606K