Provider Demographics
NPI:1699786210
Name:PHOENIX ANESTHESIA AND PAIN MANAGEMENT GROUP, PLLC
Entity type:Organization
Organization Name:PHOENIX ANESTHESIA AND PAIN MANAGEMENT GROUP, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:LISA
Authorized Official - Middle Name:C
Authorized Official - Last Name:TAYLOR-KENNEDY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:214-443-1240
Mailing Address - Street 1:14902 PRESTON RD
Mailing Address - Street 2:SUITE 404-745
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75254-9191
Mailing Address - Country:US
Mailing Address - Phone:214-443-1240
Mailing Address - Fax:214-443-1240
Practice Address - Street 1:14902 PRESTON RD
Practice Address - Street 2:SUITE 404-745
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75254-9191
Practice Address - Country:US
Practice Address - Phone:214-443-1240
Practice Address - Fax:214-443-1240
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-10
Last Update Date:2007-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ2989207L00000X, 207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXBCBS FACILITY 0042HWOtherLISA TAYLOR-KENNEDY, MD
TXBCBS PROVIDER 8G0150OtherLISA TAYLOR-KENNEDY, MD
TX00802QMedicare PIN
TXBCBS PROVIDER 8G0150OtherLISA TAYLOR-KENNEDY, MD