MEDICARE: CHRISTOPHER ROBERT LYNCH CST,CSFA, RN

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	163W00000X	Registered Nurse	808232	TX
2	246ZC0007X	Surgical Assistant	151900
3	246ZS0410X	Surgical Technologist	100964

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	100964	OTHER		CST,CFA
2	808232	OTHER	TX	RN
3	151900	OTHER		CST/CSFA

General Provider Information

NPI Number	:	1114044542
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTOPHER ROBERT LYNCH CST,CSFA, RN

Provider Business Mailing Address
First Line	:	PO BOX 101292
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76185-1292
Country	:	US
Telephone Number	:	817-852-6927
Fax Number	:	817-531-2939

Provider Business Practice Location Address
First Line	:	4216 SW LOOP 820
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76109-5350
Country	:	US
Telephone Number	:	817-852-6927
Fax Number	:	817-531-2939

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

Provider Enumeration Date	:	03/22/2007
Last Update Date	:	09/23/2015

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