Provider Demographics
NPI:1871738062
Name:PROFESSIONAL ANESTHESIA ASSOCIATES, PC
Entity type:Organization
Organization Name:PROFESSIONAL ANESTHESIA ASSOCIATES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:CLIFFORD
Authorized Official - Last Name:ALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:205-370-2381
Mailing Address - Street 1:3411 GARTH RD # 136
Mailing Address - Street 2:
Mailing Address - City:BAYTOWN
Mailing Address - State:TX
Mailing Address - Zip Code:77521-3851
Mailing Address - Country:US
Mailing Address - Phone:205-370-2381
Mailing Address - Fax:
Practice Address - Street 1:3107 W COLORADO AVE # 300
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80904-2040
Practice Address - Country:US
Practice Address - Phone:205-370-2381
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-03
Last Update Date:2009-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty