Provider Demographics
NPI:1871883876
Name:PREMIER ANESTHESIA GOUP LLP
Entity type:Organization
Organization Name:PREMIER ANESTHESIA GOUP LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALIST
Authorized Official - Prefix:
Authorized Official - First Name:JERE
Authorized Official - Middle Name:
Authorized Official - Last Name:ODOM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-884-4444
Mailing Address - Street 1:10400 N CENTRAL EXPY
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75231-2297
Mailing Address - Country:US
Mailing Address - Phone:972-884-4444
Mailing Address - Fax:214-594-2848
Practice Address - Street 1:10400 NORTH CENTRAL EXPRESSWAY
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-2297
Practice Address - Country:US
Practice Address - Phone:972-884-4444
Practice Address - Fax:214-594-2848
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-11
Last Update Date:2011-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty