Healthcare Provider Details

I. General information

NPI: 1104966951
Provider Name (Legal Business Name): THOMAS J PALUCH CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/08/2007
Last Update Date: 11/13/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 HOSPITAL DR
TARBORO NC
27886-2011
US

IV. Provider business mailing address

1015 SAINT ANDREW ST
TARBORO NC
27886-3842
US

V. Phone/Fax

Practice location:
  • Phone: 252-641-7170
  • Fax: 252-641-7373
Mailing address:
  • Phone: 252-823-8944
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number078681
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number034405
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: