MEDICARE: STEVEN HEATH COBB 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	085769	SC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	APRN 4421	OTHER	SC	APRN
2	085769	OTHER	SC	AANA

General Provider Information

NPI Number	:	1316241938
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEVEN HEATH COBB CRNA

Provider Business Mailing Address
First Line	:	1 INDEPENDENCE PT
Second Line	:	SUITE 212
City	:	GREENVILLE
State	:	SC
Zip	:	29615-4545
Country	:	US
Telephone Number	:	864-797-6307
Fax Number	:	864-797-6198

Provider Business Practice Location Address
First Line	:	701 GROVE RD
Second Line	:
City	:	GREENVILLE
State	:	SC
Zip	:	29605-4295
Country	:	US
Telephone Number	:	864-455-7111
Fax Number	:

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

Provider Enumeration Date	:	12/23/2010
Last Update Date	:	03/21/2014

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