Healthcare Provider Details

I. General information

NPI: 1013249945
Provider Name (Legal Business Name): CMM TRI-COUNTY ANESTHESIA STAFFING SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/03/2010
Last Update Date: 02/03/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

64 STARR DR
TROY MI
48083-1646
US

IV. Provider business mailing address

5623 E DUNBAR RD
MONROE MI
48161-9127
US

V. Phone/Fax

Practice location:
  • Phone: 248-470-9986
  • Fax: 734-241-0014
Mailing address:
  • Phone: 734-241-3891
  • Fax: 734-241-0014

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number4704232638
License Number StateMI

VIII. Authorized Official

Name: MR. CHRISTOPHER YOUST
Title or Position: PARTNER
Credential: CRNA
Phone: 248-470-9986