Organization
FREDERICKSBURG ANESTHESIA CONSULTANTS, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL RAY HICKS DR. (PRESIDENT/ CMO)
(954) 838-2371
Entity
Organization
Contact information
Practice address
132 E HOSPITAL DR, ANGLETON, TX 77515-4112
(972) 715-5000
Mailing address
PO BOX 650802, DALLAS, TX 75265-0802
(972) 715-5000
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
—
—
207LP2900X
Pain Medicine (Anesthesiology) Physician
—
—
363A00000X
Physician Assistant
—
—
363L00000X
Nurse Practitioner
—
—
367500000X
Certified Registered Nurse Anesthetist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
219219703
—
TX
Enumeration date
09/27/2010
Last updated
09/13/2019
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