Provider Demographics
NPI:1770160616
Name:ADDISON ANESTHESIA PLLC
Entity type:Organization
Organization Name:ADDISON ANESTHESIA PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:MYOUNG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-502-9981
Mailing Address - Street 1:PO BOX 260195
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75026-0195
Mailing Address - Country:US
Mailing Address - Phone:972-502-9981
Mailing Address - Fax:
Practice Address - Street 1:17051 DALLAS PKWY STE 100
Practice Address - Street 2:
Practice Address - City:ADDISON
Practice Address - State:TX
Practice Address - Zip Code:75001-7102
Practice Address - Country:US
Practice Address - Phone:972-502-9981
Practice Address - Fax:888-590-6624
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-26
Last Update Date:2021-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty