Healthcare Provider Details

I. General information

NPI: 1710224068
Provider Name (Legal Business Name): JOSEPH SCOTT GAREIS CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/07/2013
Last Update Date: 01/07/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6580 JUDSON RD
LONGVIEW TX
75605-7076
US

IV. Provider business mailing address

PO BOX 5188
LONGVIEW TX
75608-5188
US

V. Phone/Fax

Practice location:
  • Phone: 800-939-7440
  • Fax: 214-382-5417
Mailing address:
  • Phone: 800-939-7440
  • Fax: 214-382-5417

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberR0069924
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: