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General NPI Number Information
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NPI Number | 1043809726
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Entity Type | Individual
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Provider Name | VIDELS BOBBY MECHA CRNA
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Gender | Male
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Dates
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Enumeration Date | 01/15/2021
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Last Update Date | 10/07/2025
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Provider Practice Location Address
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Address Line | 600 HIGHLAND AVE
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City | MADISON
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State | WI
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Zip | 53792-7632
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Country | US
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Telephone | 608-263-8100
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Fax | 608-262-6247
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Provider Business Mailing Address
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Address Line | PO BOX 840853
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City | DALLAS
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State | TX
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Zip | 75284-4917
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Country | US
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Telephone | 972-233-1999
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Fax | 972-233-3666
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 1027310
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 317196
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License Number State | AZ
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Taxonomy #3
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 1027310
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License Number State | TX
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Taxonomy #4
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 802492
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License Number State | WI
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