MEDICARE: CHARLES W DINWIDDIE 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	APN8781	TN

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	P00136014	OTHER	TN	RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	01070162	OTHER	TN	AMERIGROUP TENNCARE ONLY
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	4070725	OTHER	TN	BC/BS OF TN - NETWORKS P, S, BLUESELECT, BLUECARE

General Provider Information

NPI Number	:	1497831242
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHARLES W DINWIDDIE CRNA

Provider Business Mailing Address
First Line	:	PO BOX 440352
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37244-0352
Country	:	US
Telephone Number	:	615-620-2320
Fax Number	:	615-620-2323

Provider Business Practice Location Address
First Line	:	2835 HIGHWAY 231 N
Second Line	:
City	:	SHELBYVILLE
State	:	TN
Zip	:	37160-7327
Country	:	US
Telephone Number	:	931-685-5433
Fax Number	:

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

Provider Enumeration Date	:	10/27/2006
Last Update Date	:	05/13/2010

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