Organization
EAST TEXAS MEDICAL CENTER HENDERSON
Active
Parent organization
EAST TEXAS MEDICAL CENTER HENDERSON
Other names
ETMC Henderson CRNA
Organization subpart
Yes
Provider details
NPI number
Legal business name
EAST TEXAS MEDICAL CENTER HENDERSON
Authorized official
MR. MARK S LEITNER (ADMINISTRATOR)
(903) 655-3616
Entity
Organization
Contact information
Practice address
300 WILSON ST, HENDERSON, TX 75652-5956
(903) 657-7541
(903) 657-4009
Mailing address
300 WILSON ST, HENDERSON, TX 75652-5956
(903) 657-7541
(903) 657-4009
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
220328301
—
TX
Enumeration date
05/14/2009
Last updated
07/19/2011
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