| Organization Name: | GLENWOOD ANESTHESIA MANAGEMENT |
| NPI Number: | 1073976684 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | TRACY WALLS (PRESIDENT) |
| Mailing Address: | 17051 Dallas Pkwy Suite 100 Addison |
| State: | TX US |
| Postal Code: | 750017109 |
| Phone Number: | 9729160521 |
| Fax Number: | 9722340212 |
| NPI Enumeration Date: | 03/31/2016 |
| NPI Last Update Date: | 04/20/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QP3300X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Pain |
| Taxonomy Definition: | |