MEDICARE: DIANE W FOX 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	APN550	SC
2	367500000X	Certified Registered Nurse Anesthetist	209006226	IL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	430024203	OTHER	SC	RAILROAD MEDICARE

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	:	1700886413
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DIANE W FOX CRNA

Provider Business Mailing Address
First Line	:	25 E BAY ST
Second Line	:
City	:	GEORGETOWN
State	:	SC
Zip	:	29440-3788
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	25 E BAY ST
Second Line	:
City	:	GEORGETOWN
State	:	SC
Zip	:	29440-3788
Country	:	US
Telephone Number	:	843-546-5025
Fax Number	:

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

Provider Enumeration Date	:	07/22/2005
Last Update Date	:	01/23/2015

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Directions to “ DIANE W FOX CRNA” Practice Location

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