Provider Demographics
NPI:1700189925
Name:FREDERICK S UTTER MHS CRNA PC
Entity Type:Organization
Organization Name:FREDERICK S UTTER MHS CRNA PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FREDERICK
Authorized Official - Middle Name:STUART
Authorized Official - Last Name:UTTER
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:915-494-8779
Mailing Address - Street 1:9895 ALAMEDA AVE STE 108
Mailing Address - Street 2:
Mailing Address - City:SOCORRO
Mailing Address - State:TX
Mailing Address - Zip Code:79927-2976
Mailing Address - Country:US
Mailing Address - Phone:915-772-4551
Mailing Address - Fax:915-232-9920
Practice Address - Street 1:1900 DENVER AVE
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79902-3008
Practice Address - Country:US
Practice Address - Phone:915-407-6035
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-09
Last Update Date:2022-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX283576101Medicaid
NM78621348Medicaid