MEDICARE: WESLEY S MAHAN 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
1	367500000X	Certified Registered Nurse Anesthetist	ARNP1549802	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	P00029835	OTHER	FL	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	G0087	OTHER	FL	BLUE CROSS BLUE SHIELD
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1265524144
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WESLEY S MAHAN JR. CRNA

Provider Business Mailing Address
First Line	:	5606 WESTSHORE DR
Second Line	:
City	:	NEW PORT RICHEY
State	:	FL
Zip	:	34652-3032
Country	:	US
Telephone Number	:	727-846-0065
Fax Number	:

Provider Business Practice Location Address
First Line	:	5606 WESTSHORE DR
Second Line	:
City	:	NEW PORT RICHEY
State	:	FL
Zip	:	34652-3032
Country	:	US
Telephone Number	:	727-846-0065
Fax Number	:

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

Provider Enumeration Date	:	09/29/2006
Last Update Date	:	07/08/2010

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