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NPI Code Detail

MEDICARE: RICK CORBETT CRNA

MEDICARE: RICK CORBETT 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 Anesthetist209002579IL
2367500000XCertified Registered Nurse Anesthetist28184077AIN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1000000946369OTHERINANTHEM PROVIDER NUMBER
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1902881733
Entity Type Code : Individual
Provider Name (Legal Business Name) : RICK CORBETT CRNA
Provider Business Mailing Address
First Line : 500 ANDRA DR
Second Line :
City : MARYVILLE
State : IL
Zip : 62062-5796
Country : US
Telephone Number : 618-343-0048
Fax Number : 618-343-0048
Provider Business Practice Location Address
First Line : 2100 MADISON AVE
Second Line :
City : GRANITE CITY
State : IL
Zip : 62040-4701
Country : US
Telephone Number : 618-343-0048
Fax Number : 618-343-0048
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/14/2005
Last Update Date : 12/21/2015

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Directions to “ RICK CORBETT CRNA” Practice Location

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