MEDICARE: MR. RICHARD HARRY TEE 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	023260	NC
2	367500000X	Certified Registered Nurse Anesthetist	47279	NC

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	:	1346251964
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. RICHARD HARRY TEE CRNA

Provider Business Mailing Address
First Line	:	PO BOX 707
Second Line	:
City	:	PLYMOUTH
State	:	NC
Zip	:	27962-0707
Country	:	US
Telephone Number	:	252-793-4135
Fax Number	:	252-793-7740

Provider Business Practice Location Address
First Line	:	958 U.S. HWY 64 EAST
Second Line	:
City	:	PLYMOUTH
State	:	NC
Zip	:	27962-9216
Country	:	US
Telephone Number	:	252-793-4135
Fax Number	:	252-793-7740

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

Provider Enumeration Date	:	08/10/2006
Last Update Date	:	02/09/2011

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