Healthcare Provider Details

I. General information

NPI: 1962478396
Provider Name (Legal Business Name): KEITH S. SIMS CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: KEITH SZYMANSKI

II. Dates (important events)

Enumeration Date: 02/25/2006
Last Update Date: 08/01/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MEDICAL PARK #8 #200
COLUMBIA SC
29203
US

IV. Provider business mailing address

510 DEPOT ST APT 200
COLUMBIA SC
29201-2272
US

V. Phone/Fax

Practice location:
  • Phone: 803-296-2548
  • Fax:
Mailing address:
  • Phone: 803-509-4056
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberARNP2604032
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: