County of Ward
Organization Active NPI Certified Registered Nurse Anesthetist · Monahans, TX
NPI 1104906718 · NPPES record last updated Jan 28, 2014
Key facts
- NPI
- 1104906718
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Certified Registered Nurse Anesthetist 367500000X
- License
- 468 (TX)
- Legal business name
- COUNTY OF WARD
- Practice address
- 406 S Gary Ave
Monahans, TX 79756-4799 - Phone
- (432) 943-2511
- Fax
- (432) 943-6833
- NPI assigned
- Oct 17, 2006
- Organization subpart
- No
Authorized official
- Name
- Mrs. Leticia Rodriguez
- Title
- Ceo
- Phone
- (432) 943-2511
Other NPIs on the same Medicare enrollment 4
Corporate family (same tax ID) 6
Practitioners 14
-
Shane Bailey, PA
-
Jordan Bond Cooper, C.R.N.A.
-
Nzonguti Ekangaki, CRNA
-
Jennifer Brook Hada-Ondriezek, D.P.M.
-
Jamie Perez, MSN, RN, FNP-C
-
Keal Rasavage, CRNA
-
Tamara L Vaught, APRN, CRNA, PMHNP-C
-
Matthew Garrett Weaver, CRNA
-
Kama D. Winn, FNP
-
Talha Bashir, M.D, M.B,B.S
-
Eman Boulis, MD
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TX
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040414001322 | TX | Part B Supplier - Clinic/Group Practice | 1456261494 |
Receives reassigned benefits from 59 practitioners 4 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Monahans, TX |
National Provider Directory
- Tax ID family
- Judith a Moss DO
Locations
813 E 4th St
Monahans, TX 79756
Phone (432) 943-2068
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Certified Registered Nurse Anesthetist |
367500000X | 468 | TX | Yes |
Addresses
Primary practice location
406 S Gary Ave
Monahans, TX 79756-4799
Mailing address
PO Box 40
Monahans, TX 79756-0040
Phone (432) 943-2511
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 136331901 | Medicaid | TX | |
| 00C79E | Other | TX | BLUE CROSS CRNA |
Other names
- Ward Memorial Hospital
Other providers in Monahans, TX
- Gabriella M Carrillo
- Frances Carter
- Jorge David Castro Alvirena
- Subramanyeswaraswamy Chinni
- County of Ward
- County of Ward
- County of Ward
- County of Ward
- County of Ward
- County of Ward
All providers in Monahans, TX · Certified Registered Nurse Anesthetist in Texas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 28, 2014. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.