MEDICARE: RICHARD MARSHALL CHILDS 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	606135	TX

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	:	1538111885
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RICHARD MARSHALL CHILDS CRNA

Provider Business Mailing Address
First Line	:	4916 OVERTON PLZ
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76109-4415
Country	:	US
Telephone Number	:	888-804-3000
Fax Number	:	817-334-0235

Provider Business Practice Location Address
First Line	:	6551 HARRIS PKWY
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76132-6103
Country	:	US
Telephone Number	:	817-346-0988
Fax Number	:	817-334-0235

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

Provider Enumeration Date	:	05/16/2006
Last Update Date	:	01/12/2021

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