| Mr Dwight M Hall, CRNA | |
|
300 Wilson St, Henderson, TX 75652-5956 | |
| (903) 657-7541 | |
| (903) 596-7541 |
| Full Name | Mr Dwight M Hall |
|---|---|
| Gender | Male |
| Speciality | Certified Registered Nurse Anesthetist (crna) |
| Experience | 30 Years |
| Location | 300 Wilson St, Henderson, Texas |
| 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 |
|---|---|---|---|
| 1770582736 | NPI | - | NPPES |
| 85006U | Other | TX | BLUE CROSS BLUE SHIELD |
| 088614504 | Medicaid | TX |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 367500000X | Nurse Anesthetist, Certified Registered | 47045 (Texas) | Primary |
| Facility Name | Location | Facility Type |
|---|---|---|
| Christus Good Shepherd Medical Center | Longview, TX | Hospital |
| Group Practice Name | Group PECOS PAC ID | No. of Members |
|---|---|---|
| Grasshopper Anesthesia Services Pllc | 3072882315 | 44 |
| Entity Name | Christus Good Shepherd Medical Center |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1760908404 PECOS PAC ID: 3779565544 Enrollment ID: O20040604000400 |
| Entity Name | Texas Anesthesia Partners, Pllc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1144673468 PECOS PAC ID: 3870879828 Enrollment ID: O20170406000406 |
| Entity Name | Grasshopper Anesthesia Services Pllc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1932635752 PECOS PAC ID: 3072882315 Enrollment ID: O20170630000438 |
| Entity Name | Henderson Hospital Llc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1043710437 PECOS PAC ID: 4789946054 Enrollment ID: O20180326002460 |
| Entity Name | Emergenchealth Pllc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1467970897 PECOS PAC ID: 1355606641 Enrollment ID: O20180608000439 |
| Mailing Address | Practice Location Address |
|---|---|
| Mr Dwight M Hall, CRNA 1110 Turner Dr, Longview, TX 75601-6750 Ph: (903) 720-1459 | Mr Dwight M Hall, CRNA 300 Wilson St, Henderson, TX 75652-5956 Ph: (903) 657-7541 |
Mr. Jerry C Wheeler, CRNA Nurse Anesthetist - CR Medicare: Medicare Enrolled Practice Location: 300 Wilson St, Henderson, TX 75652 Phone: 903-655-3830 |