Basic Information
| Provider Information | |||||||||
| NPI: | 1306088471 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CRNA SERVICES OF DGH | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 2239 | ||||||||
| Address2: | |||||||||
| City: | DECATUR | ||||||||
| State: | AL | ||||||||
| PostalCode: | 356092239 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2563412000 | ||||||||
| FaxNumber: | 2563061691 | ||||||||
| Practice Location | |||||||||
| Address1: | 1201 7TH ST SE | ||||||||
| Address2: | |||||||||
| City: | DECATUR | ||||||||
| State: | AL | ||||||||
| PostalCode: | 356013337 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2563412000 | ||||||||
| FaxNumber: | 2563061691 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/03/2009 | ||||||||
| LastUpdateDate: | 02/07/2013 | ||||||||
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| AuthorizedOfficialLastName: | CROWE | ||||||||
| AuthorizedOfficialFirstName: | DANNY | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 2563412000 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | H5202 | AL | Y | 193400000X SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
ID Information
| ID | Type | State | Issuer | Description | 110735 | 05 | AL | MEDICAID | DP9284 | 01 | AL | RR MEDICARE | OTHER |