NPIMap

Organization Active NPI

Wilson Anesthesia Lubbock PA

  • Certified Registered Nurse Anesthetist
  • Lubbock, TX
National Provider Identifier
1144910498
Registry record updated May 10, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
Legal business name
WILSON ANESTHESIA LUBBOCK PA
Practice address
4315 28TH St
Lubbock, TX 79410-2507
Phone
(806) 792-2104
Fax
(806) 792-2134
NPI assigned
May 10, 2023
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 10, 2023

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

Authorized official

Name
Dr. Justin E. Anderson, MDNPI 1508916370
Title
President
Phone
(806) 792-2104

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
Certified Registered Nurse AnesthetistGroup: 193400000X SINGLE SPECIALTY GROUP 367500000X Primary

Addresses

Primary practice location

4315 28TH St
Lubbock, TX 79410-2507

Mailing address

4315 28TH St
Lubbock, TX 79410-2507
Phone (806) 792-2104

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20230814001021 TX Part B Supplier - Clinic/Group Practice 5496117145 Receives reassigned benefits from 4 practitioners
Practice locations: Lubbock, TX

National Provider Directory

National Provider Directory

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1683676800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1683676800000",
    "number": "1144910498",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4315 28TH ST",
            "city": "LUBBOCK",
            "state": "TX",
            "postal_code": "794102507",
            "telephone_number": "806-792-2104",
            "fax_number": "806-792-2134"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4315 28TH ST",
            "city": "LUBBOCK",
            "state": "TX",
            "postal_code": "794102507",
            "telephone_number": "806-792-2104",
            "fax_number": "806-792-2134"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WILSON ANESTHESIA LUBBOCK PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-05-10",
        "last_updated": "2023-05-10",
        "certification_date": "2023-05-10",
        "status": "A",
        "authorized_official_last_name": "ANDERSON",
        "authorized_official_first_name": "JUSTIN",
        "authorized_official_middle_name": "E.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "806-792-2104",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lubbock, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 10, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.