MEDICARE: MR. FRED THOMAS HURST JR. 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	2023035281	MO
2	367500000X	Certified Registered Nurse Anesthetist	R861818	MS
3	367500000X	Certified Registered Nurse Anesthetist	861818	IN

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
2	4244301	OTHER	TN	BLUE CROSS BLUE SHIELD OF TN
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1841247954
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. FRED THOMAS HURST JR. CRNA

Provider Business Mailing Address
First Line	:	250 N SHADELAND AVE
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46219-4959
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	68 REDFERN TRL
Second Line	:
City	:	PETAL
State	:	MS
Zip	:	39465-9415
Country	:	US
Telephone Number	:	601-310-6813
Fax Number	:

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

Provider Enumeration Date	:	05/27/2006
Last Update Date	:	05/23/2025

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Directions to “ MR. FRED THOMAS HURST JR. CRNA” Practice Location

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