MEDICARE: JEFFREY BELL

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	295819-4406	UT

General Provider Information

NPI Number	:	1063790574
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JEFFREY BELL

Provider Business Mailing Address
First Line	:	1180 N WINSTON DR
Second Line	:
City	:	KAYSVILLE
State	:	UT
Zip	:	84037-1353
Country	:	US
Telephone Number	:	801-690-6019
Fax Number	:

Provider Business Practice Location Address
First Line	:	1485 E 3900 S
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84124-1438
Country	:	US
Telephone Number	:	801-277-2062
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT OWNER
Name	:	MR. JEFFREY LOGAN BELL
Credential	:	CRNA
Telephone Number	:	801-690-6019

Provider Enumeration Date	:	08/01/2011
Last Update Date	:	09/08/2011

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