Organization
EAST TEXAS MEDICAL CENTER
Active
Other names
ETMC CRNA SERVICES
Organization subpart
No
Provider details
NPI number
Authorized official
LAURIE M HALL (OPERATIONS MANAGER)
(903) 526-1068
Entity
Organization
Contact information
Practice address
1000 S BECKHAM AVE, TYLER, TX 75701-1908
(903) 526-1068
(903) 593-4290
Mailing address
PO BOX 8027, TYLER, TX 75711-8027
(903) 526-1068
(903) 593-4290
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00C99S
GROUP NUMBER TX BCBS
TX
01
—
DE1328
GROUP NUMBER RR MCR
TX
Enumeration date
01/09/2007
Last updated
08/22/2020
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