Provider Demographics
NPI:1306953963
Name:SOUTHEAST TEXAS FREELANCE ANESTHESIA PC
Entity type:Organization
Organization Name:SOUTHEAST TEXAS FREELANCE ANESTHESIA PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:GUY
Authorized Official - Middle Name:LEROY
Authorized Official - Last Name:ABBEY
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:979-968-3362
Mailing Address - Street 1:PO BOX 388
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:KS
Mailing Address - Zip Code:67114-0388
Mailing Address - Country:US
Mailing Address - Phone:316-281-3700
Mailing Address - Fax:316-282-4322
Practice Address - Street 1:1 SAINT MARKS PL
Practice Address - Street 2:
Practice Address - City:LA GRANGE
Practice Address - State:TX
Practice Address - Zip Code:78945-1250
Practice Address - Country:US
Practice Address - Phone:979-968-3166
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-23
Last Update Date:2008-06-05
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
TX00C94COtherBCBS
TX007123501Medicaid
TX00C94COtherBCBS
TXC94CMedicare PIN