Healthcare Provider Details

I. General information

NPI: 1881611713
Provider Name (Legal Business Name): ANESTHESIA CRITICAL CARE NURSING,PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/16/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2203 SUMMERLON CIR
DODGE CITY KS
67801-2985
US

IV. Provider business mailing address

100 W ROSS BLVD STE B
DODGE CITY KS
67801-7216
US

V. Phone/Fax

Practice location:
  • Phone: 620-408-9454
  • Fax: 620-408-9552
Mailing address:
  • Phone: 620-225-2847
  • Fax: 620-225-7046

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License Number
License Number State

VIII. Authorized Official

Name: MR. TERRY MARTIN
Title or Position: OWNER
Credential: CRNA
Phone: 620-225-2847