MEDICARE: CYNTHIA A PODSEDNIK 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	247932	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	00DX86	OTHER	TX	BCBSTX
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1922111939
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CYNTHIA A PODSEDNIK CRNA

Provider Business Mailing Address
First Line	:	PO BOX 2626
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76113-2626
Country	:	US
Telephone Number	:	817-294-7444
Fax Number	:	817-294-7172

Provider Business Practice Location Address
First Line	:	5744 LYNDON B JOHNSON FWY
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75240-6322
Country	:	US
Telephone Number	:	972-490-4333
Fax Number	:

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

Provider Enumeration Date	:	08/16/2006
Last Update Date	:	08/14/2008

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