MEDICARE: RENWA ANESTHESIA, PLLC

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	00C15S	OTHER	TX	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1215028808
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RENWA ANESTHESIA, PLLC

Provider Business Mailing Address
First Line	:	PO BOX 11219
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76110-0219
Country	:	US
Telephone Number	:	817-294-7444
Fax Number	:

Provider Business Practice Location Address
First Line	:	6445 HARRIS PKWY STE 150
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76132-4140
Country	:	US
Telephone Number	:	817-294-7444
Fax Number	:

Authorized Official
Title or Position	:	MANAGING PARTNER
Name	:	ROSE ANN RENOUF
Credential	:	C.R.N.A.
Telephone Number	:	817-294-7444

Provider Enumeration Date	:	09/27/2006
Last Update Date	:	11/14/2011

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Directions to “RENWA ANESTHESIA, PLLC ” Practice Location

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