Provider Demographics
NPI:1164482196
Name:GANES, TRACY (CRNA)
Entity Type:Individual
Prefix:MRS
First Name:TRACY
Middle Name:
Last Name:GANES
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 E HOSPITAL STREET
Mailing Address - Street 2:ANESTHESIA DEPARTMENT
Mailing Address - City:MANNING
Mailing Address - State:SC
Mailing Address - Zip Code:29102
Mailing Address - Country:US
Mailing Address - Phone:803-435-8463
Mailing Address - Fax:
Practice Address - Street 1:10 E HOSPITAL STREET
Practice Address - Street 2:ANESTHESIA DEPARTMENT
Practice Address - City:MANNING
Practice Address - State:SC
Practice Address - Zip Code:29102
Practice Address - Country:US
Practice Address - Phone:803-435-8463
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2014-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCAPN2641367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCAN1441Medicaid
SC2641OtherLICENSE
SCAN1441Medicaid