=====================================================
General NPI Number Information
=====================================================
NPI Number | 1043497530
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MATTHEW THOMAS SIMPSON CRNA
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/28/2008
-----------------------------------------------------
Last Update Date | 07/13/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4777 E GALBRAITH RD
-----------------------------------------------------
City | CINCINNATI
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45236-2725
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 513-686-5077
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1100 SOUTHFIELD DR STE 1370
-----------------------------------------------------
City | PLAINFIELD
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46168-4300
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 513-319-6151
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 367500000X
-----------------------------------------------------
Taxonomy Name | Certified Registered Nurse Anesthetist
-----------------------------------------------------
License Number | COA.09879-NA
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------