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1770581001

NPI Code Detail

MEDICARE: TERESA LYNN TOOMBS CRNA

MEDICARE: TERESA LYNN TOOMBS 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	93952	OK
2	367500000X	Certified Registered Nurse Anesthetist	4704279215	MI
3	367500000X	Certified Registered Nurse Anesthetist	572751	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	88460U	OTHER	TX	BCBS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	4308712170	OTHER	MI	BCBS
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	82710	OTHER	AR	BLUE CROSS
7	83898U	OTHER	TX	BLUE CROSS
8	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1770581001
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TERESA LYNN TOOMBS CRNA

Provider Business Mailing Address
First Line	:	PO BOX 579
Second Line	:
City	:	PARK HILL
State	:	OK
Zip	:	74451-0579
Country	:	US
Telephone Number	:	918-772-0990
Fax Number	:

Provider Business Practice Location Address
First Line	:	1400 E DOWNING ST
Second Line	:
City	:	TAHLEQUAH
State	:	OK
Zip	:	74464-3324
Country	:	US
Telephone Number	:	918-453-2148
Fax Number	:

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

Provider Enumeration Date	:	07/11/2005
Last Update Date	:	02/27/2018

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Directions to “ TERESA LYNN TOOMBS CRNA” Practice Location

Language	Start Address	Practice Location

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