Thomas Vincent Mahoney, CRNA

Individual provider Active NPI Certified Registered Nurse Anesthetist · Gladewater, TX

NPI 1821144262 · NPPES record last updated Apr 22, 2024

Key facts

NPI
1821144262
Entity type
Individual (NPI type 1)
Primary specialty
Certified Registered Nurse Anesthetist 367500000X
License
237852 (TX)
Practice address
1605 E Lake Dr
Gladewater, TX 75647-9204
Phone
(903) 845-2361
NPI assigned
Jan 26, 2007
Sex
Male
Sole proprietor
No

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
Yes
Credentials
Certified Registered Nurse

State licenses

LicenseStateTypeSpecialty
237852TXMDCertified Registered Nurse Anesthetist

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Certified Registered Nurse Anesthetist 367500000X 237852 TX Yes

Addresses

Primary practice location

1605 E Lake Dr
Gladewater, TX 75647-9204

Mailing address

1605 E Lake Dr
Gladewater, TX 75647-9204
Phone (903) 845-2361

Other practice location 1

2001 N Jefferson Ave
Mount Pleasant, TX 75455-2338
Phone (903) 577-6000

Other providers in Gladewater, TX

All providers in Gladewater, TX · Certified Registered Nurse Anesthetist in Texas

Sources for this page

Verify at the official NPI Registry.