Organization
REGIONAL ANESTHESIA SVS LC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. PHILIP STREETMAN CRNA (OWNER)
(918) 649-3426
Entity
Organization
Contact information
Practice address
105 WALL ST, POTEAU, OK 74953-4433
(918) 649-3426
Mailing address
PO BOX 727, POTEAU, OK 74953-0727
(918) 649-3426
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
23472
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
363399510002
OK BLUE CROSS BLUE SHILED
OK
01
—
445484005001
OK BLUE CROSS BLUE SHILED
OK
01
—
74953A001
CHAMPUS
OK
01
—
91578
ARK BLUE CROSS BLUE SHILE
AR
Enumeration date
10/23/2006
Last updated
02/26/2008
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