Healthcare Provider Details

I. General information

NPI: 1932571551
Provider Name (Legal Business Name): MISSION NURSING ANESTHESIA, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/22/2015
Last Update Date: 12/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35800 BOB HOPE DR SUITE 100
RANCHO MIRAGE CA
92270-1739
US

IV. Provider business mailing address

PO BOX 290664
NASHVILLE TN
37229-0664
US

V. Phone/Fax

Practice location:
  • Phone: 615-620-2320
  • Fax: 615-620-2323
Mailing address:
  • Phone: 615-620-2320
  • Fax: 615-620-2323

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number State

VIII. Authorized Official

Name: SCOTT ROBERTS
Title or Position: OPERATIONS MGR
Credential:
Phone: 615-620-2324