Provider Demographics
NPI:1982623922
Name:ANESTHESIA ASSOCIATES OF KERRVILLE PLLC
Entity type:Organization
Organization Name:ANESTHESIA ASSOCIATES OF KERRVILLE PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:MASSEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:830-896-1344
Mailing Address - Street 1:420 WATER ST
Mailing Address - Street 2:#105-B
Mailing Address - City:KERRVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78028-5200
Mailing Address - Country:US
Mailing Address - Phone:830-896-1344
Mailing Address - Fax:830-896-1363
Practice Address - Street 1:551 HILL COUNTRY DR
Practice Address - Street 2:
Practice Address - City:KERRVILLE
Practice Address - State:TX
Practice Address - Zip Code:78028-6085
Practice Address - Country:US
Practice Address - Phone:830-896-1344
Practice Address - Fax:830-896-1363
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-19
Last Update Date:2012-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXC64BOtherBCBSTX
TX110842501Medicaid
TXC64BOtherBCBSTX