MEDICARE: DAVID J CINCO CRNA

Medicare Provider Information

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	R026267	SD

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	4992577	OTHER	SD	BLUE CROSS OF SD
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
8	R026267	OTHER	SD	DAKOTACARE
9	0008162	OTHER	SD	WELLMARK

NPI Number	:	1205821048
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID J CINCO CRNA

Provider Business Mailing Address
First Line	:	4500 W 69TH ST
Second Line	:
City	:	SIOUX FALLS
State	:	SD
Zip	:	57108-8148
Country	:	US
Telephone Number	:	605-977-7000
Fax Number	:	605-977-7001

Provider Business Practice Location Address
First Line	:	4500 W 69TH ST
Second Line	:
City	:	SIOUX FALLS
State	:	SD
Zip	:	57108-8148
Country	:	US
Telephone Number	:	605-977-7000
Fax Number	:	605-977-7001

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

Provider Enumeration Date	:	09/19/2005
Last Update Date	:	06/16/2008

2500 E 52ND ST N , CIGNA MEDICARE SERVICES
SIOUX FALLS, SD
57104-7106

Practice Phone: 605-373-0100
Practice Fax: