EAST TEXAS MEDICAL CENTER HENDERSON (NPI# 1083848352) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1083848352 |
| Entity Type | Organization |
| Organization Name | EAST TEXAS MEDICAL CENTER HENDERSON |
| Other Organization Name | ETMC HENDERSON CRNA |
| Practice Address |
300 Wilson St Henderson TX 75652-5956 |
| Practice Telephone | 9036577541 |
| Practice Fax Number | 9036574009 |
| Mailing Telephone | 9036577541 |
| Mailing Fax Number | 9036574009 |
| Enumeration Date | 2009-05-14 |
| Last Update Date | 2011-07-19 |
| Authorized Official Name | MR. MARK S LEITNER (ADMINISTRATOR) |
| Authorized Official Telephone | 9036553616 |
| Is Organization Subpart | Y |
| Parent Organization Name | EAST TEXAS MEDICAL CENTER HENDERSON |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 367500000X | Nurse Anesthetist, Certified Registered | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| TX | 220328301 | 05 |
| Other Name | Type Code |
|---|---|
| ETMC Henderson CRNA | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1215164231 | East Texas Medical Center Henderson | General Acute Care Hospital | 300 Wilson, Henderson, TX 75652-5956 | 2009-06-17 |
| 1942437967 | East Texas Medical Center Henderson | General Acute Care Hospital | 300 Wilson St, Henderson, TX 75652-5956 | 2009-06-17 |
| 1376777649 | East Texas Medical Center Henderson | Clinic/Center | 300 Wilson St, Henderson, TX 75652-5956 | 2009-05-14 |
| 1720212095 | East Texas Medical Center Henderson | Medicare Defined Swing Bed Unit | 300 Wilson St, Henderson, TX 75652-5956 | 2009-05-14 |
| 1245464536 | East Texas Medical Center Henderson | Clinic/Center | 300 Wilson St, Henderson, TX 75652-5956 | 2009-05-14 |
| 1770717167 | East Texas Medical Center Henderson | General Acute Care Hospital | 300 Wilson St, Henderson, TX 75652-5956 | 2009-05-13 |
| Street Address |
300 WILSON ST |
| City | HENDERSON |
| State | TX |
| Zip Code | 75652-5956 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1255954509 | Shawna Elizabeth Sharp | Nurse Practitioner | 300 Wilson St, Henderson, TX 75652-5956 | 2020-05-21 |
| 1053953794 | Mica Ladon Norman | Nurse Practitioner | 300 Wilson St, Henderson, TX 75652-5956 | 2019-10-15 |
| 1639670466 | Henderson Hospital, LLC | Nurse Anesthetist, Certified Registered | 300 Wilson St, Henderson, TX 75652-5956 | 2018-02-27 |
| 1043710437 | Henderson Hospital, LLC | Internal Medicine | 300 Wilson St, Henderson, TX 75652-5956 | 2018-02-13 |
| 1952800310 | Henderson Hospital, LLC | Clinic/Center | 300 Wilson St, Henderson, TX 75652-5956 | 2018-02-12 |
| 1326546797 | Henderson Hospital, LLC | General Acute Care Hospital | 300 Wilson St, Henderson, TX 75652-5956 | 2018-01-31 |
| 1154730273 | Tanager Emergency Physicians Pllc | Emergency Medicine | 300 Wilson St, Henderson, TX 75652-5956 | 2014-08-04 |
| 1376828400 | Kwabena Agyapong Osman | General Acute Care Hospital | 300 Wilson St, Henderson, TX 75652-5956 | 2011-10-20 |
| 1679899751 | Rusk Physician Services Pa | Hospitalist | 300 Wilson St, Henderson, TX 75652-5956 | 2010-04-14 |
| 1942437967 | East Texas Medical Center Henderson | General Acute Care Hospital | 300 Wilson St, Henderson, TX 75652-5956 | 2009-06-17 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1184264384 | John Etakibuebu | Pharmacist | 2415 Hwy 79 S, Henderson, TX 75652 | 2020-01-15 |
| 1841758596 | Janet Juanita Ray | Registered Nurse | 1987 Fm 2276 N, Henderson, TX 75652 | 2019-03-12 |
| 1912490483 | Matthew Davis Acres | Dentist | 1910 Tx-43, Henderson, TX 75652 | 2018-06-11 |
| 1467863407 | Counseling Services | Counselor | 1103 Wilson Street, Henderson, TX 75652 | 2014-05-13 |
| 1285900852 | Linda June Pool | Music Therapist | 6861 Fm 1251 E., Henderson, TX 75652 | 2012-03-28 |
| 1780992586 | Furqueron & Jackson Dentistry Partnership | Dentist | 1910 State Hwy 43 East, Henderson, TX 75652 | 2010-09-15 |
| 1235396359 | Crystal Touchstone | Physical Therapy Assistant | 1010 W Main, Henderson, TX 75652 | 2008-05-16 |
| 1609082379 | D&s Residential Services | Intermediate Care Facility, Mentally Retarded | 103 Truman, Henderson, TX 75652 | 2007-05-16 |
| 1790997302 | Billy George Brown | Dentist | 300-b North High Street, Henderson, TX 75652 | 2007-05-04 |
| 1043379761 | Donna G Mason-mcfalll | Counselor | 1103 Wilson St, Henderson, TX 75652 | 2006-12-08 |
| Find all providers in zip 75652 | ||||
| Taxonomy Code | 367500000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Anesthetist, Certified Registered |
| (1) A licensed registered nurse with advanced specialty education in anesthesia who, in collaboration with appropriate health care professionals, provides preoperative, intraoperative, and postoperative care to patients and assists in management and resuscitation of critical patients in intensive care, coronary care, and emergency situations. Nurse anesthetists are certified following successful completion of credentials and state licensure review and a national examination directed by the Council on Certification of Nurse Anesthetists. (2) A registered nurse who is qualified by special training to administer anesthesia in collaboration with a physician or dentist and who can assist in the care of patients who are in critical condition. |
| Notes: Sources: (1) Council on Certification of Nurse Anesthetists, Park Ridge, IL, and Rhea, Ott, and Shafritz, The Facts On File Dictionary of Health Care Management, New York: Facts On File Publications, 1988. (2) Lexikon: Dictionary of Health Care Terms, Organizations and Acronyms for the Era of Reform, The Joint Commission on Accreditation of Healthcare Organizations, Oakbrook Terrace, Illinois: 1994, p. 548. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1790308500 | Advanced Practice Pain Management and Anesthesia Consulting Pllc | Nurse Anesthetist, Certified Registered | 317 Wilson St, Henderson, TX 75652-5957 | 2020-05-27 |
| 1386201374 | Jennifer Hope Roark | Nurse Anesthetist, Certified Registered | 566 Ruin Creek Rd., Po Drawer 59, Henderson, NC 27536-2927 | 2019-05-24 |
| 1629108105 | Mary Elizabeth Hoversten | Nurse Anesthetist, Certified Registered | 1020 S Eastern Ave, 230, Henderson, NV 89052 | 2007-03-06 |
| 1386270460 | Jacob Keith Poe | Nurse Anesthetist, Certified Registered | 566 Ruin Creek Rd, Henderson, NC 27536-2927 | 2020-03-20 |
| 1639670466 | Henderson Hospital, LLC | Nurse Anesthetist, Certified Registered | 300 Wilson St, Henderson, TX 75652-5956 | 2018-02-27 |
| 1336560028 | Jedidiah Polete | Nurse Anesthetist, Certified Registered | 129 W Lake Mead Pkwy, Suite B18, Henderson, NV 89015-6954 | 2013-12-23 |
| 1396089611 | Tami B May | Nurse Anesthetist, Certified Registered | 566 Ruin Creek Rd, Henderson, NC 27536-2927 | 2012-11-27 |
| 1235484981 | Matthew Lee Rigby | Nurse Anesthetist, Certified Registered | 129 W Lake Mead Pkwy, Suite B18, Henderson, NV 89015-6954 | 2012-07-18 |
| 1225309628 | Michael R Hagerman | Nurse Anesthetist, Certified Registered | 1305 N Elm St, Henderson, KY 42420-2783 | 2012-01-18 |
| 1013205830 | Jaime Parke | Nurse Anesthetist, Certified Registered | 129 W Lake Mead Pkwy, Suite B18, Henderson, NV 89015-6954 | 2011-07-13 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.