MEDICARE: JOHN BISTRICK C.R.N.A.

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	518727	TX

General Provider Information

NPI Number	:	1235212051
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN BISTRICK C.R.N.A.

Provider Business Mailing Address
First Line	:	1949 INDIANA ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77019-6547
Country	:	US
Telephone Number	:	832-549-6399
Fax Number	:

Provider Business Practice Location Address
First Line	:	1949 INDIANA ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77019-6547
Country	:	US
Telephone Number	:	832-549-6399
Fax Number	:

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

Provider Enumeration Date	:	10/23/2006
Last Update Date	:	07/08/2007

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