MEDICARE: MR. JEREMY MICHAEL DAVES 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	2004031152	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1063513612
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JEREMY MICHAEL DAVES CRNA

Provider Business Mailing Address
First Line	:	1209 NW NORTH RIDGE DRIVE
Second Line	:	SUITE B
City	:	BLUE SPRINGS
State	:	MO
Zip	:	64015-6320
Country	:	US
Telephone Number	:	816-988-8415
Fax Number	:	816-335-4003

Provider Business Practice Location Address
First Line	:	201 NW R D MIZE RD
Second Line	:	ANESTHESIA SERVICES OF BLUE SPRINGS/ST. MARY'S MEDICAL
City	:	BLUE SPRINGS
State	:	MO
Zip	:	64014-2513
Country	:	US
Telephone Number	:	816-988-8415
Fax Number	:	816-335-4003

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

Provider Enumeration Date	:	09/26/2006
Last Update Date	:	03/15/2013

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