MEDICARE: CLEARWATER ANESTHESIA 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	:	1538170485
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CLEARWATER ANESTHESIA PLLC

Provider Business Mailing Address
First Line	:	3301 S 14TH ST STE 16180
Second Line	:
City	:	ABILENE
State	:	TX
Zip	:	79605-5015
Country	:	US
Telephone Number	:	325-660-5535
Fax Number	:	325-692-6030

Provider Business Practice Location Address
First Line	:	6551 HARRIS PKWY
Second Line	:	SUITE 100
City	:	FORT WORTH
State	:	TX
Zip	:	76132-6103
Country	:	US
Telephone Number	:	817-346-3800
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	JEFF T WEERTMAN
Credential	:	CRNA
Telephone Number	:	817-723-9174

Provider Enumeration Date	:	08/10/2006
Last Update Date	:	01/12/2021

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