Healthcare Provider Details

I. General information

NPI: 1114973906
Provider Name (Legal Business Name): DAVID CARL BOSE CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/25/2006
Last Update Date: 03/21/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 E THORPE ST
LAKIN KS
67860-9625
US

IV. Provider business mailing address

PO BOX 821 P.O. BOX 1023
HAYS KS
67601-0821
US

V. Phone/Fax

Practice location:
  • Phone: 620-355-7111
  • Fax: 620-355-1527
Mailing address:
  • Phone: 785-628-8300
  • Fax: 785-623-4634

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number55452
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: