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NPI Code Detail

MEDICARE: SAMUEL V DAVENPORT CRNA

MEDICARE: SAMUEL V DAVENPORT 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
1367500000XCertified Registered Nurse AnesthetistRN0000104846TN

Other Identifiers

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

General Provider Information

NPI Number : 1083616056
Entity Type Code : Individual
Provider Name (Legal Business Name) : SAMUEL V DAVENPORT CRNA
Provider Business Mailing Address
First Line : 1009 LARK ST STE 2
Second Line :
City : JOHNSON CITY
State : TN
Zip : 37604-8218
Country : US
Telephone Number : 423-283-0776
Fax Number : 423-283-0549
Provider Business Practice Location Address
First Line : 400 N STATE OF FRANKLIN RD
Second Line :
City : JOHNSON CITY
State : TN
Zip : 37604-6035
Country : US
Telephone Number : 423-431-6111
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/10/2005
Last Update Date : 04/24/2019

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Directions to “ SAMUEL V DAVENPORT CRNA” Practice Location

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