Organization
MTC ANESTHESIA, LLP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. TERESA DIANNE GARDNER CRNA (GENERAL PARTNER)
(214) 320-3975
Entity
Organization
Contact information
Practice address
9301 N CENTRAL EXPY, DALLAS, TX 75231-0806
(214) 265-2810
(214) 265-2820
Mailing address
5027 LILAC LN, DALLAS, TX 75209-3329
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00C91S
BLUE CROSS BLUE SHIELD
TX
Enumeration date
07/08/2006
Last updated
08/22/2020
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