Organization
FREDERICKSBURG ANESTHESIA CONSULTANTS PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL RAY HICKS MD (CMO/PRESIDENT)
(954) 838-2371
Entity
Organization
Contact information
Practice address
1020 S STATE HIGHWAY 16, FREDERICKSBURG, TX 78624-4471
(830) 997-4353
Mailing address
PO BOX 650802, DALLAS, TX 75265-0802
(954) 838-2371
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
—
—
207L00000X
Anesthesiology Physician
Primary
—
—
207LP2900X
Pain Medicine (Anesthesiology) Physician
—
—
363A00000X
Physician Assistant
—
—
363L00000X
Nurse Practitioner
—
—
363LF0000X
Family Nurse Practitioner
—
—
367500000X
Certified Registered Nurse Anesthetist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
219219701
—
TX
Enumeration date
07/15/2010
Last updated
09/13/2019
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