Provider Demographics
NPI:1194848192
Name:SPHINX ANESTHESIA PROVDIDERS, PA
Entity type:Organization
Organization Name:SPHINX ANESTHESIA PROVDIDERS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:UDAYA
Authorized Official - Middle Name:B
Authorized Official - Last Name:PADAKANDLA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:214-696-3540
Mailing Address - Street 1:10830 N. CENTRAL EXPRESSWAY
Mailing Address - Street 2:CENTRAL SQUARE, SUITE 300
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75206
Mailing Address - Country:US
Mailing Address - Phone:214-696-3540
Mailing Address - Fax:214-696-1230
Practice Address - Street 1:3500 GASTON AVE
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75246-2017
Practice Address - Country:US
Practice Address - Phone:214-820-3296
Practice Address - Fax:866-289-2081
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK-6209207LC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LC0200XAllopathic & Osteopathic PhysiciansAnesthesiologyCritical Care MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00528UMedicare ID - Type UnspecifiedGROUP NUMBER
TX8A2161Medicare PIN
TXG21808Medicare UPIN