Provider Demographics
NPI:1316097975
Name:BG ANESTHESIA, P.A.
Entity type:Organization
Organization Name:BG ANESTHESIA, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:J
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:806-799-2093
Mailing Address - Street 1:6812 WAYNE AVE STE E
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79424-1633
Mailing Address - Country:US
Mailing Address - Phone:806-799-2093
Mailing Address - Fax:806-783-0277
Practice Address - Street 1:6812 WAYNE AVE STE E
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79424-1633
Practice Address - Country:US
Practice Address - Phone:806-799-2093
Practice Address - Fax:806-783-0277
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-12
Last Update Date:2019-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX094925701Medicaid
TX094925701Medicaid