Organization
TIERRA ALTA ANESTHESIA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. PETER HOLTZ CRNA (PRESIDENT)
(573) 686-5550
Entity
Organization
Contact information
Practice address
1010 SPRUCE ST, ESPANOLA, NM 87532-3456
(573) 686-5550
Mailing address
209 S MAIN ST, POPLAR BLUFF, MO 63901-5831
(573) 686-5550
(573) 686-2136
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
—
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
NM006869
BCBSNM GROUP
NM
Enumeration date
07/27/2005
Last updated
07/21/2022
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