| Mr Martin E Rivera, CRNA | |
|
2626 S Jackson, Jacksonville, TX 75766 | |
| (903) 541-4630 | |
| (903) 586-5710 |
| Full Name | Mr Martin E Rivera |
|---|---|
| Gender | Male |
| Speciality | Nurse Anesthetist, Certified Registered |
| Location | 2626 S Jackson, Jacksonville, Texas |
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1184694416 | NPI | - | NPPES |
| 917426801 | Medicaid | MO |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 367500000X | Nurse Anesthetist, Certified Registered | 073074 (Missouri) | Secondary |
| 367500000X | Nurse Anesthetist, Certified Registered | 1139215 (Texas) | Primary |
| Entity Name | Mother Frances Hospital Jacksonville |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1952306672 PECOS PAC ID: 5597751024 Enrollment ID: O20040421001092 |
| 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 Martin E Rivera, CRNA Po Box 220, Rolla, MO 65402-0220 Ph: (573) 458-8899 | Mr Martin E Rivera, CRNA 2626 S Jackson, Jacksonville, TX 75766 Ph: (903) 541-4630 |
Mr. Barry Lynn Thibodeaux, CRNA Nurse Anesthetist - CR Medicare: Not Enrolled in Medicare Practice Location: 1463 Se Loop 456, Jacksonville, TX 75766 Phone: 903-589-1150 | |
David Newsom, CRNA Nurse Anesthetist - CR Medicare: Accepting Medicare Assignments Practice Location: 501 S Ragsdale St, Jacksonville, TX 75766 Phone: 903-677-1000 Fax: 903-677-1694 | |
Timothy B Different, CRNA Nurse Anesthetist - CR Medicare: Accepting Medicare Assignments Practice Location: 2026 S Jackson St, Jacksonville, TX 75766 Phone: 903-586-5678 Fax: 903-541-4679 | |
Mr. Jack David Capps, CRNA Nurse Anesthetist - CR Medicare: Not Enrolled in Medicare Practice Location: 2026 S Jackson St, Jacksonville, TX 75766 Phone: 903-541-4500 |