MEDICARE: JOHN L POMPER 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	163W00000X	Registered Nurse	RN-246719-L	PA
2	367500000X	Certified Registered Nurse Anesthetist	038533	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	84347	OTHER	PA	GEISINGER
2	0448668	OTHER	PA	FIRST PRIORITY
3	50026737	OTHER	PA	CAPITAL ADVANTAGE
4	728009000	OTHER	PA	IBC
5	0448668	OTHER	PA	HIGHMARK
6	2000104	OTHER	PA	KHP CENTRAL
7	1585157	OTHER	PA	GATEWAY
8	9532437	OTHER	PA	AETNA

General Provider Information

NPI Number	:	1558367250
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN L POMPER CRNA

Provider Business Mailing Address
First Line	:	PO BOX 8500-1776
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19178-0001
Country	:	US
Telephone Number	:	201-804-2800
Fax Number	:

Provider Business Practice Location Address
First Line	:	111 S 11TH ST # 8490
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19107-4824
Country	:	US
Telephone Number	:	215-955-6161
Fax Number	:	215-923-5507

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

Provider Enumeration Date	:	06/27/2005
Last Update Date	:	03/13/2015

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Directions to “ JOHN L POMPER CRNA” Practice Location

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