Provider Demographics
NPI:1508821547
Name:CROSSETT HEALTH FOUNDATION
Entity Type:Organization
Organization Name:CROSSETT HEALTH FOUNDATION
Other - Org Name:ASHLEY COUNTY ANESTHESIA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:RUSS
Authorized Official - Middle Name:
Authorized Official - Last Name:SWORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-364-1280
Mailing Address - Street 1:400 E 10TH ST
Mailing Address - Street 2:
Mailing Address - City:WACONIA
Mailing Address - State:MN
Mailing Address - Zip Code:55387-4552
Mailing Address - Country:US
Mailing Address - Phone:952-442-9770
Mailing Address - Fax:952-442-3630
Practice Address - Street 1:1015 UNITY RD
Practice Address - Street 2:
Practice Address - City:CROSSETT
Practice Address - State:AR
Practice Address - Zip Code:71635-9443
Practice Address - Country:US
Practice Address - Phone:870-364-1280
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CROSSETT HEALTH FOUNDATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-04-20
Last Update Date:2008-03-17
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
AR5C503OtherBLUE CROSS OF AR
ARCG5305Medicare ID - Type UnspecifiedRAILROAD MEDICARE