Provider Demographics
NPI:1497186092
Name:SPECIALIZED CRNA SERVICES L.L.C.
Entity Type:Organization
Organization Name:SPECIALIZED CRNA SERVICES L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:C
Authorized Official - Last Name:ELLES
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:832-423-4422
Mailing Address - Street 1:25511 BUDDE RD STE 2502
Mailing Address - Street 2:
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77380-2388
Mailing Address - Country:US
Mailing Address - Phone:832-616-5560
Mailing Address - Fax:866-475-9062
Practice Address - Street 1:5115 MAIN ST STE 1000
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77002-9749
Practice Address - Country:US
Practice Address - Phone:713-580-2500
Practice Address - Fax:713-580-2596
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-06
Last Update Date:2022-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX501103/40277367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX81995UOtherBCBS
TX137815002Medicaid
TX430032292OtherRAILROAD MEDICARE
TX81995UOtherBCBS
TX00C46MMedicare PIN