Organization
GENESIS ANESTHESIA, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
THEODOOR CHRISTIAAN HANCKE CRNA (GROUP PRESIDENT)
(817) 529-2650
Entity
Organization
Contact information
Practice address
850 ED HALL DR, KAUFMAN, TX 75142-1861
(972) 932-7344
Mailing address
4100 INTERNATIONAL PLZ, SUITE 600, FORT WORTH, TX 76109-4820
(817) 529-2650
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
—
—
Other
Enumeration date
06/30/2016
Last updated
06/30/2016
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