Dale G Moore (NPI# 1861436248, PAC ID# 5193624492) is a physician enrolled in Centers for Medicare & Medicaid Services (CMS). The primary specialty is CERTIFIED REGISTERED NURSE ANESTHETIST (CRNA).
| Nation Provider ID (NPI) | 1861436248 |
| PAC ID by PECOS | 5193624492 |
| Professional Enrollment ID | I20040106000438 |
| Full Name | Dale G Moore |
| Organization Legal Name | EDEN ANESTHESIA SERVICES INC |
| Address |
31 N Saint Joseph Ave Niles MI 49120-2207 |
| Phone Number | 2696871879 |
| Gender | M |
| Credential | CNA |
| Graduation Year | 1992 |
| Primary Specialty | CERTIFIED REGISTERED NURSE ANESTHETIST (CRNA) |
| Group Practice PAC ID | 8628041597 |
| Number of Group Practice Members | 13 |
| Accepts Medicare Assignment | Y |
| Claim Control Number (CCN) | Legal Business Name |
|---|---|
| 230021 | LAKELAND HOSPITAL, ST JOSEPH |
| Address | Phone | Organization |
|---|---|---|
| 31 N Saint Joseph Ave, Niles, MI 49120-2207 | 2696871879 | EDEN ANESTHESIA SERVICES INC |
| Organization Legal Name | EDEN ANESTHESIA SERVICES INC |
| Physicians | 8 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Christopher L Holman | Certified Registered Nurse Anesthetist (crna) | Eden Anesthesia Services Inc | 31 N Saint Joseph Ave, Niles, MI 49120-2207 |
| Andrew C Wirebaugh | Certified Registered Nurse Anesthetist (crna) | Eden Anesthesia Services Inc | 31 N Saint Joseph Ave, Niles, MI 49120-2207 |
| Ryan T Hagley | Certified Registered Nurse Anesthetist (crna) | Eden Anesthesia Services Inc | 31 N Saint Joseph Ave, Niles, MI 49120-2207 |
| Denise C Brown | Certified Registered Nurse Anesthetist (crna) | Eden Anesthesia Services Inc | 31 N Saint Joseph Ave, Niles, MI 49120-2207 |
| Megan Sobbry - Hagley | Certified Registered Nurse Anesthetist (crna) | Eden Anesthesia Services Inc | 31 N Saint Joseph Ave, Niles, MI 49120-2207 |
| Lucas A Gravelyn | Certified Registered Nurse Anesthetist | Eden Anesthesia Services Inc | 31 N Saint Joseph Ave, Niles, MI 49120-2207 |
| Daniel G Judge | Anesthesiology | Eden Anesthesia Services Inc | 31 N Saint Joseph Ave, Niles, MI 49120-2207 |
| Street Address |
31 N SAINT JOSEPH AVE |
| City | NILES |
| State | MI |
| Zip | 49120-2207 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Christopher L Holman | Certified Registered Nurse Anesthetist (crna) | Eden Anesthesia Services Inc | 31 N Saint Joseph Ave, Niles, MI 49120-2207 |
| Andrew C Wirebaugh | Certified Registered Nurse Anesthetist (crna) | Eden Anesthesia Services Inc | 31 N Saint Joseph Ave, Niles, MI 49120-2207 |
| Kevin A Hoffman | Emergency Medicine | Epmg Southwest Michigan Pllc | 31 N Saint Joseph Ave, Niles, MI 49120-2207 |
| Ryan T Hagley | Certified Registered Nurse Anesthetist (crna) | Eden Anesthesia Services Inc | 31 N Saint Joseph Ave, Niles, MI 49120-2207 |
| Denise C Brown | Certified Registered Nurse Anesthetist (crna) | Eden Anesthesia Services Inc | 31 N Saint Joseph Ave, Niles, MI 49120-2207 |
| Sam William Campbell | Emergency Medicine | Epmg Southwest Michigan Pllc | 31 N Saint Joseph Ave, Niles, MI 49120-2207 |
| Jereme Paul Long | Emergency Medicine | Epmg Southwest Michigan Pllc | 31 N Saint Joseph Ave, Niles, MI 49120-2207 |
| Megan Sobbry - Hagley | Certified Registered Nurse Anesthetist (crna) | Eden Anesthesia Services Inc | 31 N Saint Joseph Ave, Niles, MI 49120-2207 |
| Megan A Schrader | Emergency Medicine | Epmg Southwest Michigan Pllc | 31 N Saint Joseph Ave, Niles, MI 49120-2207 |
| James P Kelly Iii | Nurse Practitioner | Epmg Southwest Michigan Pllc | 31 N Saint Joseph Ave, Niles, MI 49120-2207 |
| Find all physicians in the same address | |||
| Name | Specialty | Organization | Address |
|---|---|---|---|
| William H Fox | Podiatry | 201 N 17th St, Niles, MI 49120-2100 | |
| Kristen A Whitworth | Emergency Medicine | Epmg Southwest Michigan Pllc | 31 N Saint Joseph Ave, Niles, MI 49120-2207 |
| Lucas A Gravelyn | Certified Registered Nurse Anesthetist | Eden Anesthesia Services Inc | 31 N Saint Joseph Ave, Niles, MI 49120-2207 |
| Daniel G Judge | Anesthesiology | Eden Anesthesia Services Inc | 31 N Saint Joseph Ave, Niles, MI 49120-2207 |
| William G Busso | Certified Registered Nurse Anesthetist | Eden Anesthesia Services Inc. | 31 N Saint Joseph Ave, Niles, MI 49120-2207 |
| Scott L Coddington | Certified Registered Nurse Anesthetist | Eden Anesthesia Services Inc. | 31 N Saint Joseph Ave, Niles, MI 49120-2207 |
| Laurie Ann Gee | Nurse Practitioner | Lakeland Medical Practices | 42 N St Joseph Ave, 201 Swmc Womens Health, Niles, MI 49120-2208 |
| Aaron Lanning | Nurse Practitioner | Lakeland Medical Practices | 42 N St Joseph Ave, 300 Lakeland Ear Nose and Throat, Niles, MI 49120-2208 |
| Sharon A Rooney Gandy | General Surgery | Lakeland Medical Practices | 42 N St Joseph Ave, 103 Lakeland Center for Wound Care and Hyperbaric Medi, Niles, MI 49120-2208 |
| Kenneth W Kaufmann Ii | Obstetrics/gynecology | Lakeland Medical Practices | 42 N St Joseph Ave, 201 Swmc Womens Health, Niles, MI 49120-2208 |
| Find all physicians in zip 49120 | |||
| City | NILES |
| Zip Code | 49120 |
| Specialty | CERTIFIED REGISTERED NURSE ANESTHETIST (CRNA) |
| City + Specialty | NILES + CERTIFIED REGISTERED NURSE ANESTHETIST (CRNA) |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS) |
| Jurisdiction | Medicare |
This dataset includes 1.12 million groups, individual physicians, and other clinicians currently enrolled in Medicare. Each physician is registered with NPI, PAC ID, full name, specialty, phone, organization, hospital, address, medical school, etc.