Provider Demographics
NPI:1699719922
Name:BRAZOS ANESTHESIOLOGY ASSOCIATES, P.A.
Entity type:Organization
Organization Name:BRAZOS ANESTHESIOLOGY ASSOCIATES, P.A.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KENNI
Authorized Official - Middle Name:J
Authorized Official - Last Name:BULGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:979-776-4777
Mailing Address - Street 1:1737 BRIARCREST DR
Mailing Address - Street 2:SUITE 14
Mailing Address - City:BRYAN
Mailing Address - State:TX
Mailing Address - Zip Code:77802-2769
Mailing Address - Country:US
Mailing Address - Phone:979-776-4777
Mailing Address - Fax:979-776-0588
Practice Address - Street 1:1737 BRIARCREST DR
Practice Address - Street 2:SUITE 14
Practice Address - City:BRYAN
Practice Address - State:TX
Practice Address - Zip Code:77802-2769
Practice Address - Country:US
Practice Address - Phone:979-776-3777
Practice Address - Fax:979-776-0588
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-16
Last Update Date:2008-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00C07EMedicare PIN
TXCS3826Medicare PIN
TX00G958Medicare PIN