MEDICARE: ALBERT ARREDONDO JR. MSN, 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	0087300	OK
2	163W00000X	Registered Nurse	0087300	OK
3	163W00000X	Registered Nurse	648163	TX
4	367500000X	Certified Registered Nurse Anesthetist	648163	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1316917420
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALBERT ARREDONDO JR. MSN, CRNA

Provider Business Mailing Address
First Line	:	7801 NW BRADY WAY
Second Line	:
City	:	LAWTON
State	:	OK
Zip	:	73505-0600
Country	:	US
Telephone Number	:	210-386-8008
Fax Number	:

Provider Business Practice Location Address
First Line	:	4301 MOW-WAY RD
Second Line	:	RACH (ATTN:MCUA-QC, MS. PRESCOTT)
City	:	FORT SILL
State	:	OK
Zip	:	73505-6300
Country	:	US
Telephone Number	:	580-458-2134
Fax Number	:	580-458-2314

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

Provider Enumeration Date	:	01/23/2006
Last Update Date	:	12/18/2017

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