Provider Demographics
NPI:1528178019
Name:ENTERPRISE ANESTHESIA SERVICES, PLLC
Entity type:Organization
Organization Name:ENTERPRISE ANESTHESIA SERVICES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:POPPY
Authorized Official - Middle Name:A
Authorized Official - Last Name:WALKER
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:325-675-6466
Mailing Address - Street 1:3301 S 14TH ST STE 16180
Mailing Address - Street 2:
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79605-5015
Mailing Address - Country:US
Mailing Address - Phone:325-675-6466
Mailing Address - Fax:325-692-6030
Practice Address - Street 1:5602 HEALTH CENTER DR
Practice Address - Street 2:
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79606-1227
Practice Address - Country:US
Practice Address - Phone:325-793-3755
Practice Address - Fax:325-793-3750
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2023-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX595335367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX170450401Medicaid
TXDD3524OtherRR MEDICARE GROUP #
TX00C44SOtherBCBS GROUP #