Provider Demographics
NPI:1366497760
Name:EHS CRNA LLC
Entity Type:Organization
Organization Name:EHS CRNA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF FINANCE
Authorized Official - Prefix:MR
Authorized Official - First Name:GAYLON
Authorized Official - Middle Name:KEITH
Authorized Official - Last Name:RICHARDSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-838-6709
Mailing Address - Street 1:104 W 5TH AVE
Mailing Address - Street 2:SUITE 250E
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99204-4880
Mailing Address - Country:US
Mailing Address - Phone:509-838-6709
Mailing Address - Fax:509-835-4058
Practice Address - Street 1:104 W 5TH AVE
Practice Address - Street 2:SUITE 250E
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99204-4880
Practice Address - Country:US
Practice Address - Phone:509-838-6709
Practice Address - Fax:509-835-4058
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-23
Last Update Date:2008-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9646795Medicaid
WAG8856694Medicare PIN
WA8856694Medicare PIN
WA8856694Medicare ID - Type Unspecified
WADD8921Medicare PIN