Provider Demographics
NPI:1649425760
Name:BELTZ, JOSEPH S (CRNA)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:S
Last Name:BELTZ
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:510 E CLINTON AVE
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:TX
Mailing Address - Zip Code:75751-3410
Mailing Address - Country:US
Mailing Address - Phone:903-677-1000
Mailing Address - Fax:
Practice Address - Street 1:510 E CLINTON AVE
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:TX
Practice Address - Zip Code:75751-3410
Practice Address - Country:US
Practice Address - Phone:903-677-1000
Practice Address - Fax:903-677-1694
Is Sole Proprietor?:No
Enumeration Date:2008-11-18
Last Update Date:2020-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX678465367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX3529737-01Medicaid
TX456655YNR7Medicare PIN