MEDICARE: MR. ERIC L FLATEN CRNA

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	RN568591	CA
2	367500000X	Certified Registered Nurse Anesthetist	CRNA2646	CA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	430060085	OTHER	CA	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	NA2646	OTHER	CA	BS OF CA

General Provider Information

NPI Number	:	1063480275
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ERIC L FLATEN CRNA

Provider Business Mailing Address
First Line	:	1081 N CHINA LAKE BLVD
Second Line	:
City	:	RIDGECREST
State	:	CA
Zip	:	93555-3130
Country	:	US
Telephone Number	:	760-446-3551
Fax Number	:	760-499-3014

Provider Business Practice Location Address
First Line	:	1081 N CHINA LAKE BLVD
Second Line	:
City	:	RIDGECREST
State	:	CA
Zip	:	93555-3130
Country	:	US
Telephone Number	:	760-446-3551
Fax Number	:	760-499-3014

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/14/2006
Last Update Date	:	01/17/2013

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Directions to “ MR. ERIC L FLATEN CRNA” Practice Location

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