Basic Information
| Provider Information | |||||||||
| NPI: | 1992032619 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | UNIVERSITY OF TEXAS SOUTHWESTERN MEDICAL CENTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 845347 | ||||||||
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| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 75284 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2146487833 | ||||||||
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| Practice Location | |||||||||
| Address1: | 5323 HARRY HINES BLVD | ||||||||
| Address2: | |||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 75390 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2146487833 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/17/2009 | ||||||||
| LastUpdateDate: | 03/01/2010 | ||||||||
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| AuthorizedOfficialLastName: | SAMNANI | ||||||||
| AuthorizedOfficialFirstName: | HUSSAIN | ||||||||
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| AuthorizedOfficialTitleorPosition: | CERTIFIED REGISTERED NURSE ANESTHSI | ||||||||
| AuthorizedOfficialTelephone: | 9729002640 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| AuthorizedOfficialCredential: | REGISTERED NURSE | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | 685575 | TX | Y | 193400000X SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
No ID Information.