| Charles Derrick Wilson, CRNA | |
|
4800 48th St, Valley, AL 36854-3666 | |
| (334) 756-1848 | |
| (334) 756-1854 |
| Full Name | Charles Derrick Wilson |
|---|---|
| Gender | Male |
| Speciality | Certified Registered Nurse Anesthetist (crna) |
| Experience | 38 Years |
| Location | 4800 48th St, Valley, Alabama |
| Accepts Medicare Assignments | Yes. He accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1730146309 | NPI | - | NPPES |
| 51517977 | Other | AL | BCBSAL PROVIDER # |
| 000549381E | Medicaid | GA | |
| 051517977 | Medicaid | AL | |
| 000549381C | Medicaid | GA | |
| 000549381D | Medicaid | GA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 367500000X | Nurse Anesthetist, Certified Registered | 1-044011 (Alabama) | Secondary |
| 367500000X | Nurse Anesthetist, Certified Registered | RN065069 (Georgia) | Primary |
| Facility Name | Location | Facility Type |
|---|---|---|
| St Catherine Hospital | Garden city, KS | Hospital |
| Jack Hughston Memorial Hospital | Phenix city, AL | Hospital |
| Group Practice Name | Group PECOS PAC ID | No. of Members |
|---|---|---|
| Amsol Anesthetists Of Georgia, Llc | 5193780955 | 20 |
| Amsol Anesthetists Of Georgia, Llc | 5193780955 | 20 |
| Us Anesthesia Partners Of Kansas Pa | 7719245299 | 20 |
| Entity Name | Montgomery Anesthesia Associates, Pc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1043281553 PECOS PAC ID: 9537153572 Enrollment ID: O20040412001708 |
| Entity Name | Huntsville Hospital Anesthesia |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1851321079 PECOS PAC ID: 7315990751 Enrollment ID: O20050225000538 |
| Entity Name | Amsol Anesthetists Of Georgia, Llc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1649224775 PECOS PAC ID: 5193780955 Enrollment ID: O20080829000381 |
| Entity Name | Wilson Anesthesia Associates, Llc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1104178482 PECOS PAC ID: 5698926673 Enrollment ID: O20240201004319 |
| Mailing Address | Practice Location Address |
|---|---|
| Charles Derrick Wilson, CRNA Po Box 661495, Birmingham, AL 35266-1495 Ph: (205) 979-5882 | Charles Derrick Wilson, CRNA 4800 48th St, Valley, AL 36854-3666 Ph: (334) 756-1848 |
Thomas M Nichols, CRNA Nurse Anesthetist - CR Medicare: Not Enrolled in Medicare Practice Location: 4800 48th St, Valley, AL 36854 Phone: 334-756-1848 Fax: 334-756-1854 | |
Mr. Gary Russell Mills, CRNA Nurse Anesthetist - CR Medicare: Accepting Medicare Assignments Practice Location: 4800 48th St, Valley, AL 36854 Phone: 256-283-7878 | |
Heather Laconya Veal Fields, CRNA Nurse Anesthetist - CR Medicare: Accepting Medicare Assignments Practice Location: 4800 48th St, Valley, AL 36854 Phone: 334-756-1848 Fax: 334-756-1854 | |
James M Henderson Jr., CRNA Nurse Anesthetist - CR Medicare: Medicare Enrolled Practice Location: 4800 48th St, Valley, AL 36854 Phone: 334-756-1848 Fax: 334-756-1854 |