Glen Deitrick, CRNA - Nurse Anesthetist, Certified Registered in Gulfport, MS

Glen Deitrick, CRNA is a Nurse Anesthetist, Certified Registered based in Gulfport, Mississippi. Glen Deitrick is licensed to practice in Mississippi (license number R128610) and his current practice location is 15190 Community Rd, Suite 230a, Gulfport, Mississippi. He can be reached at his office (for appointments etc.) via phone at (228) 831-0204.

NPI number for Glen Deitrick is 1033214564 and his current mailing address is 15190 Community Rd, Suite 230a, Gulfport, Mississippi. He does not participate in medicare program and thus does not accept medicare assignments. His NPI Number is 1033214564.

Contact Information

Glen Deitrick, CRNA
15190 Community Rd, Suite 230a,
Gulfport, MS 39503-3485
(228) 831-0204
(228) 831-1868



Provider's Profile

Full NameGlen Deitrick
GenderMale
SpecialityNurse Anesthetist, Certified Registered
Location15190 Community Rd, Gulfport, Mississippi
Accepts Medicare AssignmentsDoes not participate in Medicare Program. He may not accept medicare assignment.
  NPI Data:
  • NPI Number: 1033214564
  • Provider Enumeration Date: 09/13/2006
  • Last Update Date: 07/08/2007

Medical Identifiers

Medical identifiers for Glen Deitrick such as npi, medicare ID, medicare PIN, medicaid, etc.
IdentifierTypeStateIssuer
1033214564NPI-NPPES
00111157MedicaidMS

Medical Taxonomies and Licenses

TaxonomyTypeLicense (State)Status
367500000XNurse Anesthetist, Certified Registered R128610 (Mississippi)Primary

Medicare Part D Prescriber Enrollment

Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Glen Deitrick is NOT enrolled with medicare and thus cannot prescribe medicare part D drugs to patients with medicare part D benefits.

Mailing Address and Practice Location

Mailing AddressPractice Location Address
Glen Deitrick, CRNA
15190 Community Rd, Suite 230a,
Gulfport, MS 39503-3485

Ph: (228) 831-0204
Glen Deitrick, CRNA
15190 Community Rd, Suite 230a,
Gulfport, MS 39503-3485

Ph: (228) 831-0204

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Nurse Anesthetist, Certified Registered Nurses in Gulfport, MS

Kathryn Pittman, CRNA
Nurse Anesthetist - CR
Medicare: Accepting Medicare Assignments
Practice Location: 15200 Community Rd, Gulfport, MS 39503
Phone: 228-575-7000    
Jason Wells, CRNA
Nurse Anesthetist - CR
Medicare: Accepting Medicare Assignments
Practice Location: 4500 13th St, Gulfport, MS 39501
Phone: 228-865-3281    Fax: 228-867-5117
Victor P Polito, CRNA
Nurse Anesthetist - CR
Medicare: Not Enrolled in Medicare
Practice Location: 15190 Community Rd, Suite 230a, Gulfport, MS 39503
Phone: 228-831-0204    Fax: 228-831-1868
Glen Michael Cavalier, CRNA
Nurse Anesthetist - CR
Medicare: Accepting Medicare Assignments
Practice Location: 15200 Community Rd, Gulfport, MS 39503
Phone: 228-575-7000    
Julie K Klester, CRNA
Nurse Anesthetist - CR
Medicare: Accepting Medicare Assignments
Practice Location: 15190 Community Rd, Suite 230a, Gulfport, MS 39503
Phone: 228-831-0204    Fax: 228-831-1868
Trinh Thu Weatherly, CRNA
Nurse Anesthetist - CR
Medicare: Accepting Medicare Assignments
Practice Location: 4500 13th St, Gulfport, MS 39501
Phone: 228-867-4000    

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