NPIMap

Organization Active NPI

Wise County Anesthesia Associates

  • Specialist
  • Decatur, TX
National Provider Identifier
1063552511
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
DOH9805 Issued in TX
Legal business name
WISE COUNTY ANESTHESIA ASSOCIATES
Practice address
609 Medical Center Dr
Decatur, TX 76234-4652
Phone
(940) 627-5921
NPI assigned
Feb 7, 2007
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
David Blaylock, DONPI 1396872412
Title
Owner Anesthesiologist
Phone
(940) 627-3033

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Specialist 174400000X DOH9805 TX Primary

Addresses

Primary practice location

609 Medical Center Dr
Decatur, TX 76234-4652

Mailing address

PO Box 1046
Decatur, TX 76234-4652
Phone (940) 627-3033

Other identifiers 2

IdentifierTypeStateIssuer
DOH9805OtherTXLICENSE NUMBER
3536HMOtherTXBLUE CROSS GROUP ID NUMBE

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 15

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 15

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1170806400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1063552511",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1046",
            "city": "DECATUR",
            "state": "TX",
            "postal_code": "762344652",
            "telephone_number": "940-627-3033",
            "fax_number": "940-627-3572"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "609 MEDICAL CENTER DR",
            "city": "DECATUR",
            "state": "TX",
            "postal_code": "762344652",
            "telephone_number": "940-627-5921"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WISE COUNTY ANESTHESIA ASSOCIATES",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-07",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "BLAYLOCK",
        "authorized_official_first_name": "DAVID",
        "authorized_official_title_or_position": "OWNER ANESTHESIOLOGIST",
        "authorized_official_telephone_number": "940-627-3033",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "TX",
            "license": "DOH9805",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE NUMBER",
            "identifier": "DOH9805",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS GROUP ID NUMBE",
            "identifier": "3536HM",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Decatur, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.