MEDICARE: LINDA M SUDIMACK C.R.N.A.

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	RN107666	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1518906981
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LINDA M SUDIMACK C.R.N.A.

Provider Business Mailing Address
First Line	:	5151 REED RD
Second Line	:	SUITE 105 B
City	:	COLUMBUS
State	:	OH
Zip	:	43220-2553
Country	:	US
Telephone Number	:	614-457-2306
Fax Number	:	614-884-0776

Provider Business Practice Location Address
First Line	:	5151 REED RD
Second Line	:	SUITE 105 B
City	:	COLUMBUS
State	:	OH
Zip	:	43220-2553
Country	:	US
Telephone Number	:	614-457-2306
Fax Number	:	614-884-0776

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

Provider Enumeration Date	:	06/04/2006
Last Update Date	:	07/08/2007

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