Organization
MID TEX ANESTHESIA ASSOC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GAY LYNN KENT (ADMINISTRATOR)
(254) 776-0266
Entity
Organization
Contact information
Practice address
405 LONDONDERRY DR, SUITE 105, WACO, TX 76712-7920
(254) 776-0266
(254) 776-2511
Mailing address
PO BOX 224137, DALLAS, TX 75222-4137
(254) 776-0266
(254) 776-2511
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00EZ73
BLUE CROSS BLUE SHIELD
TX
05
—
098220902
—
TX
Enumeration date
10/12/2006
Last updated
02/04/2014
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