Healthcare Provider Details

I. General information

NPI: 1174648430
Provider Name (Legal Business Name): JOHN HENRY CHILES CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/19/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

820 CLARKSVILLE ST
PARIS TX
75460-6027
US

IV. Provider business mailing address

35 COUNTY ROAD 42400
PARIS TX
75462-1409
US

V. Phone/Fax

Practice location:
  • Phone: 903-785-4521
  • Fax:
Mailing address:
  • Phone: 903-785-7258
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number233238
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: