Provider Demographics
NPI:1154378248
Name:ANESTHESIA CONSULTANTS OF LONGVIEW
Entity type:Organization
Organization Name:ANESTHESIA CONSULTANTS OF LONGVIEW
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MRS
Authorized Official - First Name:PAT
Authorized Official - Middle Name:
Authorized Official - Last Name:KEEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-315-1820
Mailing Address - Street 1:PO BOX 2527
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75606-2527
Mailing Address - Country:US
Mailing Address - Phone:903-331-0506
Mailing Address - Fax:903-331-0462
Practice Address - Street 1:438 N FREDONIA ST
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75601-6468
Practice Address - Country:US
Practice Address - Phone:903-331-0506
Practice Address - Fax:903-331-0462
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-27
Last Update Date:2012-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX084665102Medicaid
TX084665102Medicaid