Provider Demographics
NPI:1871530220
Name:SEQUOIA ANESTHESIOLOGY, PA
Entity type:Organization
Organization Name:SEQUOIA ANESTHESIOLOGY, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:BEARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-334-0530
Mailing Address - Street 1:PO BOX 99386
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76199-0386
Mailing Address - Country:US
Mailing Address - Phone:817-529-1927
Mailing Address - Fax:817-877-0350
Practice Address - Street 1:6701 OAKMONT BLVD
Practice Address - Street 2:DEPT OF ANESTHESIOLOGY/PAIN MANAGEMENT
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76132-2957
Practice Address - Country:US
Practice Address - Phone:817-370-4721
Practice Address - Fax:817-370-4941
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-01
Last Update Date:2011-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX081397401Medicaid
TX081397401Medicaid