MEDICARE: MR. JAMES A YOUNG 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	R0022980	OK

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	731092249	OTHER	OK	MEDICARE RR

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

General Provider Information

NPI Number	:	1104810043
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JAMES A YOUNG CRNA

Provider Business Mailing Address
First Line	:	PO BOX 270126
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73137-0126
Country	:	US
Telephone Number	:	405-775-9350
Fax Number	:	405-775-9360

Provider Business Practice Location Address
First Line	:	1044 SW 44TH ST
Second Line	:	STE 600
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73109-3613
Country	:	US
Telephone Number	:	405-631-4263
Fax Number	:

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

Provider Enumeration Date	:	09/07/2005
Last Update Date	:	10/30/2014

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Directions to “ MR. JAMES A YOUNG CRNA” Practice Location

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