Provider Demographics
NPI:1215961263
Name:SPECTRUM ANESTHESIA & PAIN SERVICES, P.A.
Entity type:Organization
Organization Name:SPECTRUM ANESTHESIA & PAIN SERVICES, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:E
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:956-630-6301
Mailing Address - Street 1:PO BOX 720658
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78504-0658
Mailing Address - Country:US
Mailing Address - Phone:956-630-6301
Mailing Address - Fax:956-630-6019
Practice Address - Street 1:5017 S MCCOLL RD STE D
Practice Address - Street 2:
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78539-7884
Practice Address - Country:US
Practice Address - Phone:956-630-6301
Practice Address - Fax:956-630-6019
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-10
Last Update Date:2008-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG17185207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX178476101Medicaid
TX0063NHOtherBC BS DR GROUP NO.
TX0063NHOtherBC BS DR GROUP NO.
TXG11785Medicare UPIN