MEDICARE: WILLIAM TOWNSEND 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	163W00000X	Registered Nurse	1634934	CO
2	367500000X	Certified Registered Nurse Anesthetist	6325	NC

General Provider Information

NPI Number	:	1356727614
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WILLIAM TOWNSEND CRNA

Provider Business Mailing Address
First Line	:	580 AVE OF THE CAROLINAS
Second Line	:
City	:	CARTHAGE
State	:	NC
Zip	:	28327-9839
Country	:	US
Telephone Number	:	601-942-6249
Fax Number	:

Provider Business Practice Location Address
First Line	:	2817 REILLY ST
Second Line	:
City	:	FORT BRAGG
State	:	NC
Zip	:	28310-4613
Country	:	US
Telephone Number	:	910-907-1000
Fax Number	:

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

Provider Enumeration Date	:	08/09/2015
Last Update Date	:	03/05/2020

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