Provider Demographics
NPI:1861597999
Name:CONFIDENTIAL ANESTHESIA, P.A.
Entity type:Organization
Organization Name:CONFIDENTIAL ANESTHESIA, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:E
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:210-227-5168
Mailing Address - Street 1:7731 BROADWAY ST # H41
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78209-3259
Mailing Address - Country:US
Mailing Address - Phone:210-621-0640
Mailing Address - Fax:210-621-2386
Practice Address - Street 1:7731 BROADWAY ST # H41
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78209
Practice Address - Country:US
Practice Address - Phone:210-621-0640
Practice Address - Fax:210-621-2386
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-13
Last Update Date:2019-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK3856207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0048KVOtherBCBS TX GROUP
TX163147502Medicaid