Provider Demographics
NPI:1437285525
Name:GARLAND ANESTHESIA
Entity type:Organization
Organization Name:GARLAND ANESTHESIA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:TERRIE
Authorized Official - Middle Name:
Authorized Official - Last Name:BURSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-276-6100
Mailing Address - Street 1:700 WALTER REED BLVD
Mailing Address - Street 2:SUITE 305
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75042-3701
Mailing Address - Country:US
Mailing Address - Phone:972-276-6100
Mailing Address - Fax:
Practice Address - Street 1:1721 ANALOG DR
Practice Address - Street 2:
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75081-1944
Practice Address - Country:US
Practice Address - Phone:972-276-6100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-26
Last Update Date:2020-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX088577403Medicaid
TX8D3691Medicare ID - Type Unspecified