MEDICARE: DR. MARK A KOSSICK 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	163W00000X	Registered Nurse	237443	NC
2	367500000X	Certified Registered Nurse Anesthetist	036721	NC

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	:	1942296744
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARK A KOSSICK CRNA

Provider Business Mailing Address
First Line	:	1459 SAND HILL RD
Second Line	:	OFFICE 618
City	:	CANDLER
State	:	NC
Zip	:	28715-8943
Country	:	US
Telephone Number	:	828-670-8810
Fax Number	:	828-670-8816

Provider Business Practice Location Address
First Line	:	1459 SAND HILL RD
Second Line	:	OFFICE 618
City	:	CANDLER
State	:	NC
Zip	:	28715-8943
Country	:	US
Telephone Number	:	828-670-8810
Fax Number	:	828-670-8816

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

Provider Enumeration Date	:	09/27/2005
Last Update Date	:	11/17/2010

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