Healthcare Provider Details

I. General information

NPI: 1225048986
Provider Name (Legal Business Name): FRANK E SMITH CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 E SUNFLOWER RD BOLIVAR COUNTY HOSPITAL
CLEVELAND MS
38732-2833
US

IV. Provider business mailing address

27 CEDAR RD
CLEVELAND MS
38732-8731
US

V. Phone/Fax

Practice location:
  • Phone: 662-846-0061
  • Fax:
Mailing address:
  • Phone: 662-846-6521
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberR822682
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: