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NPI Code Detail

MEDICARE: JOHN E THIEL JR. CRNA

MEDICARE: JOHN E THIEL JR. 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 AnesthetistR58231SC

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 : 1093717506
Entity Type Code : Individual
Provider Name (Legal Business Name) : JOHN E THIEL JR. CRNA
Provider Business Mailing Address
First Line : 2901 MIDDLE ST
Second Line :
City : SULLIVANS ISLAND
State : SC
Zip : 29482-8644
Country : US
Telephone Number : 843-452-7205
Fax Number :
Provider Business Practice Location Address
First Line : 2095 HENRY TECKLENBURG DR
Second Line :
City : CHARLESTON
State : SC
Zip : 29414-5733
Country : US
Telephone Number : 843-452-7205
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/15/2005
Last Update Date : 07/08/2007

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