Provider Demographics
NPI:1083987093
Name:CASE ANESTHESIA, PC
Entity Type:Organization
Organization Name:CASE ANESTHESIA, PC
Other - Org Name:DBA GERARD DESJARDINS, CRNA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GERARD
Authorized Official - Middle Name:G
Authorized Official - Last Name:DESJARDINS
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:575-627-7600
Mailing Address - Street 1:P,O, BOX 664
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:NM
Mailing Address - Zip Code:88202
Mailing Address - Country:US
Mailing Address - Phone:575-622-4784
Mailing Address - Fax:575-625-1033
Practice Address - Street 1:113 E. 19TH ST.
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:NM
Practice Address - Zip Code:88201
Practice Address - Country:US
Practice Address - Phone:575-627-7000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CASE ANESTHESIA, PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-02-22
Last Update Date:2012-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMR13732367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty