Provider Demographics
NPI:1376562595
Name:CREWS-PETERS ANESTHESIA, LLC
Entity Type:Organization
Organization Name:CREWS-PETERS ANESTHESIA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CRNA
Authorized Official - Prefix:MR
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:C
Authorized Official - Last Name:PETERS
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:870-934-8010
Mailing Address - Street 1:2612 HIDDEN HILL CIR
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72404-6997
Mailing Address - Country:US
Mailing Address - Phone:870-935-7106
Mailing Address - Fax:870-934-8020
Practice Address - Street 1:623 E MATTHEWS AVE
Practice Address - Street 2:SUITE C
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72401-3145
Practice Address - Country:US
Practice Address - Phone:870-934-8010
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-19
Last Update Date:2008-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARR33596367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5F604OtherBLUE CROSS BLUE SHIELD
5F604OtherMEDICARE PTAN
DF7011OtherRAILROAD MEDICARE
5F604Medicare PIN