Provider Demographics
NPI:1407943293
Name:ALEX G CHISHOLM CRNA PC
Entity Type:Organization
Organization Name:ALEX G CHISHOLM CRNA PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ALEX
Authorized Official - Middle Name:G
Authorized Official - Last Name:CHISHOLM
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:432-520-0291
Mailing Address - Street 1:PO BOX 4157
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79704-4157
Mailing Address - Country:US
Mailing Address - Phone:432-520-0291
Mailing Address - Fax:432-520-2181
Practice Address - Street 1:2706 W CUTHBERT AVE
Practice Address - Street 2:BUILDING B, STE 100
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79701-3885
Practice Address - Country:US
Practice Address - Phone:432-520-0291
Practice Address - Fax:432-520-2181
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-05
Last Update Date:2020-08-22
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
TX00794WMedicare ID - Type Unspecified