MEDICARE: JOHN L SCOTT 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	207L00000X	Anesthesiology Physician	32007	LA

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	:	1427038827
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN L SCOTT CRNA

Provider Business Mailing Address
First Line	:	1373 JEFFERSON DR
Second Line	:
City	:	LAKE CHARLES
State	:	LA
Zip	:	70605-5539
Country	:	US
Telephone Number	:	337-478-8938
Fax Number	:

Provider Business Practice Location Address
First Line	:	751 E BAYOU PINES DR
Second Line	:	SUITE L
City	:	LAKE CHARLES
State	:	LA
Zip	:	70601-7196
Country	:	US
Telephone Number	:	337-436-8700
Fax Number	:	337-433-5942

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

Provider Enumeration Date	:	01/20/2006
Last Update Date	:	02/26/2008

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