Provider Demographics
NPI:1487106175
Name:VERTEX ANESTHESIA, PLLC
Entity type:Organization
Organization Name:VERTEX ANESTHESIA, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:M
Authorized Official - Last Name:GANO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:970-420-3471
Mailing Address - Street 1:PO BOX 112
Mailing Address - Street 2:
Mailing Address - City:MUNCIE
Mailing Address - State:IN
Mailing Address - Zip Code:47308-0112
Mailing Address - Country:US
Mailing Address - Phone:765-284-0493
Mailing Address - Fax:765-284-2434
Practice Address - Street 1:4447 N CENTRAL EXPY
Practice Address - Street 2:SUITE 110-264
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75205-4245
Practice Address - Country:US
Practice Address - Phone:970-420-3471
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-27
Last Update Date:2016-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX349432OtherMEDICAR PTAN