| Wallace Eugene Ralston, CRNA | |
|
2305 S 65 Highway, Marshall, MO 65340 | |
| (660) 886-3554 | |
| (660) 831-3308 |
| Full Name | Wallace Eugene Ralston |
|---|---|
| Gender | Male |
| Speciality | Certified Registered Nurse Anesthetist (crna) |
| Experience | 21 Years |
| Location | 2305 S 65 Highway, Marshall, Missouri |
| 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 |
|---|---|---|---|
| 1972556447 | NPI | - | NPPES |
| 30004543120001 | Medicaid | KS | |
| 918782004 | Medicaid | MO |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 363L00000X | Nurse Practitioner | 2020034592 (Missouri) | Secondary |
| 367500000X | Nurse Anesthetist, Certified Registered | 152532 (Missouri) | Primary |
| Facility Name | Location | Facility Type |
|---|---|---|
| Fitzgibbon Memorial Hospital | Marshall, MO | Hospital |
| Cedar County Memorial Hospital | El dorado springs, MO | Hospital |
| Truman Medical Center Hospital Hill | Kansas city, MO | Hospital |
| Truman Medical Center Lakewood | Kansas city, MO | Hospital |
| Group Practice Name | Group PECOS PAC ID | No. of Members |
|---|---|---|
| John Fitzgibbon Memorial Hospital Inc. | 2567351570 | 47 |
| Truman Medical Center Incorporated | 7315841418 | 218 |
| Entity Name | Truman Medical Center Incorporated |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1144207937 PECOS PAC ID: 7315841418 Enrollment ID: O20031120000847 |
| Entity Name | Plaza Anesthesia Pc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1689855694 PECOS PAC ID: 7517045842 Enrollment ID: O20080426000020 |
| Entity Name | John Fitzgibbon Memorial Hospital Inc. |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1285650176 PECOS PAC ID: 2567351570 Enrollment ID: O20080708000234 |
| Mailing Address | Practice Location Address |
|---|---|
| Wallace Eugene Ralston, CRNA 2305 South 65 Highway, Marshall, MO 65340-2640 Ph: (660) 886-7431 | Wallace Eugene Ralston, CRNA 2305 S 65 Highway, Marshall, MO 65340 Ph: (660) 886-3554 |
Ross M. Howitt, CRNA Nurse Anesthetist - CR Medicare: Not Enrolled in Medicare Practice Location: 2305 S Highway 65, Marshall, MO 65340 Phone: 660-886-7431 |