MEDICARE: JAMES BABESHOFF 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	090352	IA
2	367500000X	Certified Registered Nurse Anesthetist	NA990	CA

General Provider Information

NPI Number	:	1023011574
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMES BABESHOFF CRNA

Provider Business Mailing Address
First Line	:	PO BOX 7096
Second Line	:
City	:	STOCKTON
State	:	CA
Zip	:	95267-0096
Country	:	US
Telephone Number	:	209-956-7725
Fax Number	:	209-956-7733

Provider Business Practice Location Address
First Line	:	726 4TH ST
Second Line	:
City	:	MARYSVILLE
State	:	CA
Zip	:	95901-5656
Country	:	US
Telephone Number	:	530-749-4300
Fax Number	:

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

Provider Enumeration Date	:	05/28/2005
Last Update Date	:	10/12/2015

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