Organization
ANESTHESIA CRITICAL CARE NURSING,PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. TERRY MARTIN CRNA (OWNER)
(620) 225-2847
Entity
Organization
Contact information
Practice address
2203 SUMMERLON CIR, DODGE CITY, KS 67801-2985
(620) 408-9454
(620) 408-9552
Mailing address
100 W ROSS BLVD STE B, DODGE CITY, KS 67801-7216
(620) 225-2847
(620) 225-7046
Taxonomy
Speciality
Code
Description
License number
State
163WM0705X
Medical-Surgical Registered Nurse
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
9159799201
—
KS
Enumeration date
07/16/2006
Last updated
08/22/2020
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