Healthcare Provider Details

I. General information

NPI: 1164059218
Provider Name (Legal Business Name): DEREK M BESS CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/26/2020
Last Update Date: 06/30/2020
Certification Date: 06/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3300 MERCY HEALTH BLVD
CINCINNATI OH
45211-1103
US

IV. Provider business mailing address

2816 FLAGSTONE DR
WEST HARRISON IN
47060-6658
US

V. Phone/Fax

Practice location:
  • Phone: 513-215-5000
  • Fax:
Mailing address:
  • Phone: 513-582-6618
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number0020114
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: