Healthcare Provider Details

I. General information

NPI: 1942221726
Provider Name (Legal Business Name): STEPHEN RAY KOSTER C.R.N.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/21/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

935 WAYNE RD
SAVANNAH TN
38372-1937
US

IV. Provider business mailing address

PO BOX 1531
SAVANNAH TN
38372-4531
US

V. Phone/Fax

Practice location:
  • Phone: 731-926-8179
  • Fax:
Mailing address:
  • Phone: 731-926-8179
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberR858883
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: