| Mark Sistoso, | |
|
4301 Wilson St, Fort Sill, OK 73503-4472 | |
| (719) 205-0017 | |
| Not Available |
| Full Name | Mark Sistoso |
|---|---|
| Gender | Male |
| Speciality | Certified Registered Nurse Anesthetist (crna) |
| Experience | 12 Years |
| Location | 4301 Wilson St, Fort Sill, Oklahoma |
| 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 |
|---|---|---|---|
| 1720407752 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 367500000X | Nurse Anesthetist, Certified Registered | C003258 (Arkansas) | Secondary |
| 367500000X | Nurse Anesthetist, Certified Registered | AP60451158 (Washington) | Primary |
| Group Practice Name | Group PECOS PAC ID | No. of Members |
|---|---|---|
| Renew Medical Group Of Arkansas Ltd | 3173056298 | 108 |
| Premier Anesthesia Of Arkansas Professional Corporation | 6406077460 | 61 |
| Entity Name | Anesthesia Services Of Benton County Pa |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1013084482 PECOS PAC ID: 2264405844 Enrollment ID: O20040813000287 |
| Entity Name | Premier Anesthesia Of Arkansas Professional Corporation |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1932519485 PECOS PAC ID: 6406077460 Enrollment ID: O20141016002060 |
| Entity Name | Capital Anesthesia Solutions Of Arkansas, Llc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1174125876 PECOS PAC ID: 5395159313 Enrollment ID: O20210202001530 |
| Mailing Address | Practice Location Address |
|---|---|
| Mark Sistoso, 4 Nw Stonebrook Dr, Lawton, OK 73505-9599 Ph: (719) 205-0017 | Mark Sistoso, 4301 Wilson St, Fort Sill, OK 73503-4472 Ph: (719) 205-0017 |
Albert Arredondo Jr., MSN, CRNA Nurse Anesthetist - CR Medicare: Accepting Medicare Assignments Practice Location: 4301 Mow-way Rd, Rach (attn:mcua-qc, Ms. Prescott), Fort Sill, OK 73505 Phone: 580-458-2134 Fax: 580-458-2314 |