MEDICARE: MR. RICHARD PHILLIP KIRSCHKE CRNA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	367500000X	Certified Registered Nurse Anesthetist	113025	NC

General Provider Information

NPI Number	:	1013912757
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. RICHARD PHILLIP KIRSCHKE CRNA

Provider Business Mailing Address
First Line	:	PO BOX 237
Second Line	:
City	:	VASS
State	:	NC
Zip	:	28394-0237
Country	:	US
Telephone Number	:	910-245-3211
Fax Number	:

Provider Business Practice Location Address
First Line	:	WOMACK ARMY MEDICAL CTR
Second Line	:
City	:	FORT BRAGG
State	:	NC
Zip	:	28310-5000
Country	:	US
Telephone Number	:	910-907-7818
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/18/2005
Last Update Date	:	12/17/2007

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