Basic Information
| Provider Information | |||||||||
| NPI: | 1265427272 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HAYS | ||||||||
| FirstName: | SUSAN | ||||||||
| MiddleName: | ELLEN | ||||||||
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| Credential: | CRNA | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 840853 | ||||||||
| Address2: | |||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 752840853 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9722331999 | ||||||||
| FaxNumber: | 9722333666 | ||||||||
| Practice Location | |||||||||
| Address1: | 1500 CITYWEST BLVD | ||||||||
| Address2: | STE. 300 | ||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 77042 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7136204000 | ||||||||
| FaxNumber: | 7134584229 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/15/2005 | ||||||||
| LastUpdateDate: | 06/01/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | AP107125 | TX | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
ID Information
| ID | Type | State | Issuer | Description | 088846309 | 05 | TX | MEDICAID | 430032641 | 01 | TX | RR MEDICARE | OTHER | 83522U | 01 | TX | BLUE CROSS BLUE SHIELD | OTHER | P00225239 | 01 | TX | RAILROAD MEDICARE | OTHER | 088846304 | 05 | TX | MEDICAID | 86163U | 01 | TX | BCBS TAC HOU | OTHER | 088846305 | 05 | TX | MEDICAID | 89273C | 01 | TX | BCBS | OTHER | 046161 | 01 | TX | RECERTIFICATION AANA | OTHER |