MEDICARE: CRYSTAL ANESTHESIA SERVICES, PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	367500000X	Certified Registered Nurse Anesthetist

General Provider Information

NPI Number	:	1245683309
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CRYSTAL ANESTHESIA SERVICES, PLLC

Provider Business Mailing Address
First Line	:	950 THREADNEEDLE ST STE 250
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77079-2910
Country	:	US
Telephone Number	:	800-585-0868
Fax Number	:	713-467-0799

Provider Business Practice Location Address
First Line	:	950 THREADNEEDLE ST STE 250
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77079-2910
Country	:	US
Telephone Number	:	800-585-0868
Fax Number	:	713-467-0799

Authorized Official
Title or Position	:	OWNER OPERATOR
Name	:	ROBERT SCOTT YARISH
Credential	:	MD
Telephone Number	:	713-467-0146

Provider Enumeration Date	:	07/13/2016
Last Update Date	:	11/07/2021

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