Provider Demographics
NPI:1427512797
Name:PINE RIDGE ANESTHESIA
Entity type:Organization
Organization Name:PINE RIDGE ANESTHESIA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ADEEL
Authorized Official - Middle Name:
Authorized Official - Last Name:HAQ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:812-989-1976
Mailing Address - Street 1:4760 PRESTON RD STE 244411
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75034-8548
Mailing Address - Country:US
Mailing Address - Phone:214-390-7697
Mailing Address - Fax:972-432-6692
Practice Address - Street 1:8501 WADE BLVD # 1330
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75034-5894
Practice Address - Country:US
Practice Address - Phone:214-618-0853
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-30
Last Update Date:2022-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty