| Mr Derek C Lish, CRNA | |
|
950 Medical Dr, Brigham City, UT 84302-4724 | |
| (435) 734-9471 | |
| Not Available |
| Full Name | Mr Derek C Lish |
|---|---|
| Gender | Male |
| Speciality | Certified Registered Nurse Anesthetist (crna) |
| Experience | 16 Years |
| Location | 950 Medical Dr, Brigham City, Utah |
| 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 |
|---|---|---|---|
| 1699914044 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 367500000X | Nurse Anesthetist, Certified Registered | TEMP RNA 19861 (Idaho) | Primary |
| Facility Name | Location | Facility Type |
|---|---|---|
| Brigham City Community Hospital | Brigham city, UT | Hospital |
| Group Practice Name | Group PECOS PAC ID | No. of Members |
|---|---|---|
| Brigham Anesthesia, Llc | 9335108299 | 5 |
| Entity Name | Brigham Anesthesia, Llc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1710904800 PECOS PAC ID: 9335108299 Enrollment ID: O20041006000807 |
| Entity Name | Nph Anesthesia Of Utah Llc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1366077273 PECOS PAC ID: 9537584313 Enrollment ID: O20200811001268 |
| Mailing Address | Practice Location Address |
|---|---|
| Mr Derek C Lish, CRNA Po Box 4268, Portland, OR 97208-4268 Ph: (503) 372-2740 | Mr Derek C Lish, CRNA 950 Medical Dr, Brigham City, UT 84302-4724 Ph: (435) 734-9471 |
Penny J Ogden, CRNA Nurse Anesthetist - CR Medicare: Not Enrolled in Medicare Practice Location: 950 Medical Dr, Brigham City, UT 84302 Phone: 800-594-6399 Fax: 801-733-5618 | |
Mr. Scott Christian Phillips, CRNA Nurse Anesthetist - CR Medicare: Accepting Medicare Assignments Practice Location: 950 S 500 W, Brigham City, UT 84302 Phone: 435-734-9471 |