Healthcare Provider Details

I. General information

NPI: 1659635217
Provider Name (Legal Business Name): NEAL R. POPICHAK CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/28/2012
Last Update Date: 11/29/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 WEST 32ND ST.
JOPLIN MO
64804-0000
US

IV. Provider business mailing address

1101 26TH ST S
GREAT FALLS MT
59405-5161
US

V. Phone/Fax

Practice location:
  • Phone: 417-347-3659
  • Fax:
Mailing address:
  • Phone: 406-731-8888
  • Fax: 406-731-8876

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number98776
License Number StateWV
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number132744
License Number StateMT
# 3
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number2012019388
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: