Kelly J Black (NPI# 1881928299, PAC ID# 5193853570) is a physician enrolled in Centers for Medicare & Medicaid Services (CMS). The primary specialty is CERTIFIED REGISTERED NURSE ANESTHETIST (CRNA).
| Nation Provider ID (NPI) | 1881928299 |
| PAC ID by PECOS | 5193853570 |
| Professional Enrollment ID | I20100611000299 |
| Full Name | Kelly J Black |
| Organization Legal Name | PATRIOT ANESTHESIA |
| Address |
1007 2nd St Abernathy TX 79311-3615 |
| Phone Number | 8175168811 |
| Gender | M |
| Graduation Year | 2009 |
| Primary Specialty | CERTIFIED REGISTERED NURSE ANESTHETIST (CRNA) |
| Group Practice PAC ID | 6608139308 |
| Number of Group Practice Members | 7 |
| Accepts Medicare Assignment | Y |
| Address | Phone | Organization |
|---|---|---|
| 1007 2nd St, Abernathy, TX 79311-3615 | 8175168811 | PATRIOT ANESTHESIA |
| 6833 Plum Creek Dr, Amarillo, TX 79124-1602 | 8668772762 | PANHANDLE ANESTHESIA SERVICES, PLLC |
| Organization Legal Name | PATRIOT ANESTHESIA |
| Physicians | 3 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Jacob R Beck | Certified Registered Nurse Anesthetist (crna) | Patriot Anesthesia | 1007 2nd St, Abernathy, TX 79311-3615 |
| Paul C Wolff | Certified Registered Nurse Anesthetist (crna) | Patriot Anesthesia | 1007 2nd St, Abernathy, TX 79311-3615 |
| Street Address |
1007 2ND ST |
| City | ABERNATHY |
| State | TX |
| Zip | 79311-3615 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Jacob R Beck | Certified Registered Nurse Anesthetist (crna) | Patriot Anesthesia | 1007 2nd St, Abernathy, TX 79311-3615 |
| Paul C Wolff | Certified Registered Nurse Anesthetist (crna) | Patriot Anesthesia | 1007 2nd St, Abernathy, TX 79311-3615 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Alberta J Palmer | Nurse Practitioner | Covenant Medical Group | 409 8th St, Abernathy, TX 79311-3416 |
| Ross W. May | Physical Therapy | 207 Main St, Abernathy, TX 79311-3441 |
| City | ABERNATHY |
| Zip Code | 79311 |
| Specialty | CERTIFIED REGISTERED NURSE ANESTHETIST (CRNA) |
| City + Specialty | ABERNATHY + 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.