Healthcare Provider Details

I. General information

NPI: 1538134671
Provider Name (Legal Business Name): PATRICK A ZOSS CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/22/2006
Last Update Date: 10/24/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

42668 263RD ST
EMERY SD
57332
US

IV. Provider business mailing address

42668 263RD ST
EMERY SD
57332
US

V. Phone/Fax

Practice location:
  • Phone: 605-449-4925
  • Fax: 605-449-4925
Mailing address:
  • Phone: 605-449-4925
  • Fax: 605-449-4925

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number0543
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: