Provider Demographics
NPI:1588706485
Name:INDEPENDENT ANESTHESIA OF TEXARKANA, L.L.P
Entity type:Organization
Organization Name:INDEPENDENT ANESTHESIA OF TEXARKANA, L.L.P
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:HALEY
Authorized Official - Middle Name:C
Authorized Official - Last Name:CAMPBELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-614-5258
Mailing Address - Street 1:2602 SAINT MICHAEL DR
Mailing Address - Street 2:SUITE 301
Mailing Address - City:TEXARKANA
Mailing Address - State:TX
Mailing Address - Zip Code:75503-2387
Mailing Address - Country:US
Mailing Address - Phone:903-614-5258
Mailing Address - Fax:903-614-5260
Practice Address - Street 1:2602 SAINT MICHAEL DR
Practice Address - Street 2:SUITE 301
Practice Address - City:TEXARKANA
Practice Address - State:TX
Practice Address - Zip Code:75503-2387
Practice Address - Country:US
Practice Address - Phone:903-614-5258
Practice Address - Fax:903-614-5260
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-14
Last Update Date:2020-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXOOU52MMedicare PIN