Crawford Wallace (NPI# 1598108896, PAC ID# 8123269727) is a physician enrolled in Centers for Medicare & Medicaid Services (CMS). The primary specialty is CERTIFIED REGISTERED NURSE ANESTHETIST (CRNA).
| Nation Provider ID (NPI) | 1598108896 |
| PAC ID by PECOS | 8123269727 |
| Professional Enrollment ID | I20141014001346 |
| Full Name | Crawford Wallace |
| Organization Legal Name | DEEP SOUTH ANESTHESIA, INC |
| Address |
801 Goodyear Blvd Picayune MS 39466-3221 |
| Phone Number | 6017984711 |
| Gender | M |
| Graduation Year | 2013 |
| Primary Specialty | CERTIFIED REGISTERED NURSE ANESTHETIST (CRNA) |
| Group Practice PAC ID | 4284897612 |
| Number of Group Practice Members | 5 |
| Accepts Medicare Assignment | Y |
| Claim Control Number (CCN) | Legal Business Name |
|---|---|
| 250117 | HIGHLAND COMMUNITY HOSPITAL |
| 250082 | DELTA REGIONAL MEDICAL CENTER |
| Address | Phone | Organization |
|---|---|---|
| 1400 E Union St, Greenville, MS 38703-3246 | 6623783783 | PREMIER ANESTHESIA OF MISSISSIPPI |
| 14225 Dedeaux Rd, Gulfport, MS 39503-3369 | 2288130778 | DEEP SOUTH ANESTHESIA, INC |
| 801 Goodyear Blvd, Picayune, MS 39466-3221 | 6017984711 | DEEP SOUTH ANESTHESIA, INC |
| Organization Legal Name | DEEP SOUTH ANESTHESIA, INC |
| Physicians | 4 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Jason T Lane | Certified Registered Nurse Anesthetist (crna) | Deep South Anesthesia, Inc | 801 Goodyear Blvd, Picayune, MS 39466-3221 |
| Jed D Zak | Certified Registered Nurse Anesthetist (crna) | Deep South Anesthesia, Inc | 801 Goodyear Blvd, Picayune, MS 39466-3221 |
| Scott Carroll | Certified Registered Nurse Anesthetist (crna) | Deep South Anesthesia, Inc | 801 Goodyear Blvd, Picayune, MS 39466-3221 |
| Street Address |
801 GOODYEAR BLVD |
| City | PICAYUNE |
| State | MS |
| Zip | 39466-3221 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Jason T Lane | Certified Registered Nurse Anesthetist (crna) | Deep South Anesthesia, Inc | 801 Goodyear Blvd, Picayune, MS 39466-3221 |
| Anthony F Albright | Gastroenterology | Gastroenterology Group A Medical | 801 Goodyear Blvd, Picayune, MS 39466-3221 |
| Jed D Zak | Certified Registered Nurse Anesthetist (crna) | Deep South Anesthesia, Inc | 801 Goodyear Blvd, Picayune, MS 39466-3221 |
| Richard E Clatterbuck | Neurosurgery | Fgh Physician Billing | 801 Goodyear Blvd, Picayune, MS 39466-3221 |
| Benjamin T Rester | Interventional Cardiology | Fgh Physician Billing | 801 Goodyear Blvd, Picayune, MS 39466-3221 |
| Andrew Merlan Nida | Otolaryngology | Fgh Physician Billing | 801 Goodyear Blvd, Picayune, MS 39466-3221 |
| Scott Carroll | Certified Registered Nurse Anesthetist (crna) | Deep South Anesthesia, Inc | 801 Goodyear Blvd, Picayune, MS 39466-3221 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Walter Gipson | Family Medicine | Our Lady of The Lake Physician Group LLC | 1702 Hwy 11 N, Our Lady of The Lake Physician Group Picayune, Picayune, MS 39466-2016 |
| Adam Louis Robin | Physical Therapy | Southern Physical Therapy Clinic Inc | 1620 Hwy 11 N, Suite E, Picayune, MS 39466-2070 |
| John W Houston Jr. | Physical Therapy | Southern Physical Therapy Clinic Inc | 1620 Hwy 11 N, Suite E, Picayune, MS 39466-2070 |
| Allen R Calabresi | Hematology/oncology | Slidell Memorial Hospital | 1839 Cooper Rd, Suite 100, Picayune, MS 39466-2835 |
| Brittany Shaw | Nurse Practitioner | Pelican Urgent Care, Ms, LLC | 1839 Cooper Rd, Suite 100, Picayune, MS 39466-2835 |
| Ronald Dale Leblanc | Hematology/oncology | Slidell Memorial Hospital | 1839 Cooper Rd, Suite 100, Picayune, MS 39466-2835 |
| Mary Catherine Hess | Nurse Practitioner | Pelican Urgent Care, Ms, LLC | 1839 Cooper Rd, Suite 100, Picayune, MS 39466-2835 |
| Grace P Ford | Nurse Practitioner | Pelican Urgent Care, Ms, LLC | 1839 Cooper Rd, Suite 100, Picayune, MS 39466-2835 |
| Cyril Vk Bethala | Cardiovascular Disease (cardiology) | Cardiology Institute, Inc | 1839 Cooper Rd, Suite 100, Picayune, MS 39466-2835 |
| Judith Baker | Nurse Practitioner | Pelican Urgent Care, Ms, LLC | 1839 Cooper Rd, Suite 100, Picayune, MS 39466-2835 |
| Find all physicians in zip 39466 | |||
| City | PICAYUNE |
| Zip Code | 39466 |
| Specialty | CERTIFIED REGISTERED NURSE ANESTHETIST (CRNA) |
| City + Specialty | PICAYUNE + CERTIFIED REGISTERED NURSE ANESTHETIST (CRNA) |
Please comment or provide details below to improve the information on Crawford Wallace.
| 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.