Provider Demographics
NPI:1427430859
Name:SAGUARO ANESTHESIA ASSOCIATES, P.A.
Entity type:Organization
Organization Name:SAGUARO ANESTHESIA ASSOCIATES, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JUDSON
Authorized Official - Middle Name:J
Authorized Official - Last Name:SOMERVILLE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:956-717-2962
Mailing Address - Street 1:9114 MCPHERSON RD. STE. 2508
Mailing Address - Street 2:
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78045-6511
Mailing Address - Country:US
Mailing Address - Phone:956-717-2962
Mailing Address - Fax:956-717-0069
Practice Address - Street 1:4646 CORONA DRIVE SUITE #256
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78411
Practice Address - Country:US
Practice Address - Phone:361-806-2001
Practice Address - Fax:361-852-0626
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-22
Last Update Date:2015-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX094942201Medicaid
TX81X360OtherBCBS
TX81X360OtherBCBS