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NPI Code Detail

MEDICARE: MR. JAMES S SPANTGOS CRNA

MEDICARE: MR. JAMES S SPANTGOS 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
1367500000XCertified Registered Nurse Anesthetist080620MO
2367500000XCertified Registered Nurse AnesthetistIL

General Provider Information

NPI Number : 1376591776
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. JAMES S SPANTGOS CRNA
Provider Business Mailing Address
First Line : 1333 S SAM HOUSTON BLVD
Second Line :
City : HOUSTON
State : MO
Zip : 65483-2046
Country : US
Telephone Number : 417-967-3311
Fax Number : 417-967-3764
Provider Business Practice Location Address
First Line : 1333 S SAM HOUSTON BLVD
Second Line :
City : HOUSTON
State : MO
Zip : 65483-2046
Country : US
Telephone Number : 417-967-3311
Fax Number : 417-967-3764
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/05/2006
Last Update Date : 12/17/2007

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Directions to “ MR. JAMES S SPANTGOS CRNA” Practice Location

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