MEDICARE: COMFORT CARE ANESTHESIA LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	367500000X	Certified Registered Nurse Anesthetist	35280	WV
2	367500000X	Certified Registered Nurse Anesthetist	180984	NC
3	367500000X	Certified Registered Nurse Anesthetist	1499	SC
4	367500000X	Certified Registered Nurse Anesthetist	R143442	MD

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	DG3055	OTHER	GA	RAILROAD MEDICARE
3	469P	OTHER	MD	MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	47TCTM	OTHER	MD	CAREFIRST

General Provider Information

NPI Number	:	1003031121
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMFORT CARE ANESTHESIA LLC

Provider Business Mailing Address
First Line	:	10512 TWIN CEDAR CT
Second Line	:
City	:	LAUREL
State	:	MD
Zip	:	20723-5721
Country	:	US
Telephone Number	:	301-497-9944
Fax Number	:

Provider Business Practice Location Address
First Line	:	10512 TWIN CEDAR CT
Second Line	:
City	:	LAUREL
State	:	MD
Zip	:	20723-5721
Country	:	US
Telephone Number	:	301-497-9944
Fax Number	:

Authorized Official
Title or Position	:	CRNA
Name	:	MRS. TAWYANA MAE FLEMING
Credential	:	CRNA
Telephone Number	:	301-497-9944

Provider Enumeration Date	:	04/16/2007
Last Update Date	:	04/01/2008

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Directions to “COMFORT CARE ANESTHESIA LLC ” Practice Location

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