Healthcare Provider Details

I. General information

NPI: 1164841292
Provider Name (Legal Business Name): RANSOM JONES CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/16/2014
Last Update Date: 04/16/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1305 W 18TH ST
SIOUX FALLS SD
57105-0401
US

IV. Provider business mailing address

2209 E 63RD ST
SIOUX FALLS SD
57108-4909
US

V. Phone/Fax

Practice location:
  • Phone: 970-219-1704
  • Fax:
Mailing address:
  • Phone: 970-219-1704
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberCR000845
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: