Organization
PRIVIA MEDICAL GROUP WEST TEXAS, PLLC
Active
Other names
Anethesia & CRNA Services
Organization subpart
No
Provider details
NPI number
Authorized official
ANDREW KOUBA (CEO/AUTHORIZED OFFICIAL)
(325) 437-8645
Entity
Organization
Contact information
Practice address
1665 ANTILLEY RD, SUITE 200, ABILENE, TX 79606-5265
(325) 437-8655
(325) 437-8647
Mailing address
PO BOX 5409, ABILENE, TX 79608-5409
(325) 437-8655
(325) 437-8647
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
—
Other
Enumeration date
07/22/2005
Last updated
04/05/2022
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