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NPI Code Detail

MEDICARE: MR. GREGORY RICHARD SIMS CRNA

MEDICARE: MR. GREGORY RICHARD SIMS 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 AnesthetistAPN0000010910TN
2163W00000XRegistered NurseRN0000136483TN
3367500000XCertified Registered Nurse AnesthetistA810169MS
4163WC0200XCritical Care Medicine Registered NurseRN863786MS

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1669475315
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. GREGORY RICHARD SIMS CRNA
Provider Business Mailing Address
First Line : 1 MOCKING BIRD LN
Second Line :
City : PETAL
State : MS
Zip : 39465-9640
Country : US
Telephone Number : 601-618-9852
Fax Number :
Provider Business Practice Location Address
First Line : 5001 HARDY ST
Second Line :
City : HATTIESBURG
State : MS
Zip : 39402-1308
Country : US
Telephone Number : 601-268-8140
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/24/2005
Last Update Date : 03/10/2011

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