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NPI Code Detail

MEDICARE: MR. BRIAN ROBERT ANDERSEN C.R.N.A.

MEDICARE: MR. BRIAN ROBERT ANDERSEN 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
1367500000XCertified Registered Nurse Anesthetist705290TX

Other Identifiers

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

General Provider Information

NPI Number : 1336143940
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. BRIAN ROBERT ANDERSEN C.R.N.A.
Provider Business Mailing Address
First Line : 2241 F. M. 984
Second Line :
City : ENNIS
State : TX
Zip : 75119-0955
Country : US
Telephone Number : 972-646-5278
Fax Number : 972-646-5278
Provider Business Practice Location Address
First Line : 3201 W HIGHWAY 22
Second Line :
City : CORSICANA
State : TX
Zip : 75110-2450
Country : US
Telephone Number : 903-654-6800
Fax Number : 903-654-6989
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/10/2005
Last Update Date : 03/06/2009

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