MEDICARE: MARLEN BOB JOST 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	4704256530	MI

General Provider Information

NPI Number	:	1447300736
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARLEN BOB JOST CRNA

Provider Business Mailing Address
First Line	:	3200 SYCAMORE CT STE 1B
Second Line	:
City	:	COLUMBUS
State	:	IN
Zip	:	47203-1545
Country	:	US
Telephone Number	:	812-378-9027
Fax Number	:	812-378-1014

Provider Business Practice Location Address
First Line	:	3200 SYCAMORE CT STE 1B
Second Line	:
City	:	COLUMBUS
State	:	IN
Zip	:	47203-1545
Country	:	US
Telephone Number	:	812-378-9027
Fax Number	:	812-378-1014

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

Provider Enumeration Date	:	01/11/2007
Last Update Date	:	01/14/2026

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