Healthcare Provider Details

I. General information

NPI: 1427260694
Provider Name (Legal Business Name): SCOTT ANTHONY MCCAIN CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2007
Last Update Date: 08/18/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 MEDICAL CENTER DRIVE
SLIDELL LA
70461-5520
US

IV. Provider business mailing address

100 MEDICAL CENTER DRIVE
SLIDELL LA
70461-5520
US

V. Phone/Fax

Practice location:
  • Phone: 985-649-7070
  • Fax:
Mailing address:
  • Phone: 985-649-7070
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number100697
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN100697-AP05221
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: