Provider Demographics
NPI:1720104318
Name:ONEILL, DENNIS J (CRNA)
Entity Type:Individual
Prefix:MR
First Name:DENNIS
Middle Name:J
Last Name:ONEILL
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:PO BOX 1030
Mailing Address - Street 2:
Mailing Address - City:CHILDRESS
Mailing Address - State:TX
Mailing Address - Zip Code:79201-1030
Mailing Address - Country:US
Mailing Address - Phone:940-937-6371
Mailing Address - Fax:940-937-9128
Practice Address - Street 1:901 US HIGHWAY 83 N
Practice Address - Street 2:
Practice Address - City:CHILDRESS
Practice Address - State:TX
Practice Address - Zip Code:79201-2320
Practice Address - Country:US
Practice Address - Phone:940-937-6371
Practice Address - Fax:940-937-9128
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-22
Last Update Date:2015-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX541148367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX133250409OtherMEDICAID CRMC CRNA GROUP
TX003343304Medicaid
TX00C23LOtherCRMC CRNA BILLING SERVICES MEDICARE ID
TX133250409OtherMEDICAID CRMC CRNA GROUP