Healthcare Provider Details

I. General information

NPI: 1376642447
Provider Name (Legal Business Name): SIDNEY ALLEN MCKENZIE CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2006
Last Update Date: 03/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 W EVANS ST
FLORENCE SC
29501-3388
US

IV. Provider business mailing address

PO BOX 6467
FLORENCE SC
29502-6467
US

V. Phone/Fax

Practice location:
  • Phone: 843-679-3251
  • Fax:
Mailing address:
  • Phone: 843-679-3251
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAPN571
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: