MEDICARE: MR. STEVEN C MIMS 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	ARNP3031022	FL

General Provider Information

NPI Number	:	1063499473
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. STEVEN C MIMS CRNA

Provider Business Mailing Address
First Line	:	28071 WIRTHROP CR
Second Line	:
City	:	BONITA SPRINGS
State	:	FL
Zip	:	34134
Country	:	US
Telephone Number	:	239-770-8654
Fax Number	:	239-992-6905

Provider Business Practice Location Address
First Line	:	7152 COCA SABAL LN
Second Line	:	GOLF COAST ENDOSCOPY CTR
City	:	FT MYERS
State	:	FL
Zip	:	33908-4263
Country	:	US
Telephone Number	:	239-985-0215
Fax Number	:

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

Provider Enumeration Date	:	12/28/2005
Last Update Date	:	07/08/2007

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