Provider Demographics
NPI:1982740031
Name:SAGUARO ANESTHESIA ASSOCIATES PA
Entity type:Organization
Organization Name:SAGUARO ANESTHESIA ASSOCIATES PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JUDSON
Authorized Official - Middle Name:JEFFREY
Authorized Official - Last Name:SOMERVILLE
Authorized Official - Suffix:
Authorized Official - Credentials:M D
Authorized Official - Phone:956-717-2962
Mailing Address - Street 1:9114 MCPHERSON RD STE 2508
Mailing Address - Street 2:
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78045-6511
Mailing Address - Country:US
Mailing Address - Phone:956-717-2962
Mailing Address - Fax:956-717-0069
Practice Address - Street 1:9114 MCPHERSON RD STE 2508
Practice Address - Street 2:
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78045-6511
Practice Address - Country:US
Practice Address - Phone:956-717-2962
Practice Address - Fax:956-717-0069
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-29
Last Update Date:2015-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH6622174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0949422-01Medicaid
TX00R65HOtherBLUE CROSS BLUE SHIELD
TX00R65HMedicare PIN