MEDICARE: MARK W REYNOLDS 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	255647	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	8F7780	OTHER	TX	MEDICARE PTAN
4	P00648400	OTHER		RAILROAD MEDICARE

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
2	88808U	OTHER		BCBS

General Provider Information

NPI Number	:	1558310813
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARK W REYNOLDS CRNA

Provider Business Mailing Address
First Line	:	6506 REDSTONE CT
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76001-8108
Country	:	US
Telephone Number	:	817-419-9799
Fax Number	:	817-419-9759

Provider Business Practice Location Address
First Line	:	6506 REDSTONE CT
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76001-8108
Country	:	US
Telephone Number	:	817-419-9799
Fax Number	:	817-419-9759

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

Provider Enumeration Date	:	05/06/2006
Last Update Date	:	03/08/2009

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Directions to “ MARK W REYNOLDS CRNA” Practice Location

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