Healthcare Provider Details

I. General information

NPI: 1457881096
Provider Name (Legal Business Name): JOHN COBLENTZ JR. CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/15/2017
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7 INDEPENDENCE PT STE 300
GREENVILLE SC
29615-4569
US

IV. Provider business mailing address

115 MAPLEWOOD CT
SENECA SC
29672-0470
US

V. Phone/Fax

Practice location:
  • Phone: 864-522-3700
  • Fax: 864-522-3705
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number31678
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: