Healthcare Provider Details

I. General information

NPI: 1609843713
Provider Name (Legal Business Name): BARTLETT KINCAID SNYDER CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/07/2006
Last Update Date: 11/11/2020
Certification Date: 11/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

TAYLOR AT MARION STREETS PALMETTO HEALTH BAPTIST
COLUMBIA SC
29201
US

IV. Provider business mailing address

293 GREYSTONE BLVD FIRST FLOOR
COLUMBIA SC
29210-8004
US

V. Phone/Fax

Practice location:
  • Phone: 803-296-2548
  • Fax: 803-296-2548
Mailing address:
  • Phone: 803-296-2548
  • Fax: 803-296-2548

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number1732
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: