MEDICARE: MRS. CAROL O LUCAS 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	518261	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	100878100	OTHER	TX	FIRSTCARE
2	00C59R	OTHER	TX	BLUE CROSS BLUE SHIELD
3	742929703	OTHER	TX	HUMANA/MILITARY
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1487642260
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CAROL O LUCAS CRNA

Provider Business Mailing Address
First Line	:	8408 TYHURST DR
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78749-3522
Country	:	US
Telephone Number	:	512-751-0753
Fax Number	:

Provider Business Practice Location Address
First Line	:	3201 HIGHWAY 71 E
Second Line	:
City	:	BASTROP
State	:	TX
Zip	:	78602-5126
Country	:	US
Telephone Number	:	512-751-0753
Fax Number	:

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

Provider Enumeration Date	:	10/06/2005
Last Update Date	:	05/21/2008

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