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NPI Code Detail

MEDICARE: BART R PRESTON CRNA

MEDICARE: BART R PRESTON 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
1367500000XCertified Registered Nurse Anesthetist200347-4406UT

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1107008987102OTHERUTIHC
266114OTHERUTPEHP
3660761OTHERUTDESERET MUTUAL
402003474401001OTHERUTBCBS
5PRA05806OTHERUTMOLINA
65581OTHERUTHEALTHY U
7QM0000054865OTHERUTALTIUS

General Provider Information

NPI Number : 1598861304
Entity Type Code : Individual
Provider Name (Legal Business Name) : BART R PRESTON CRNA
Provider Business Mailing Address
First Line : 1954 FORT UNION BLVD STE 114
Second Line :
City : SALT LAKE CITY
State : UT
Zip : 84121-6899
Country : US
Telephone Number : 800-594-5736
Fax Number :
Provider Business Practice Location Address
First Line : 1954 FORT UNION BLVD STE 114
Second Line :
City : SALT LAKE CITY
State : UT
Zip : 84121-6899
Country : US
Telephone Number : 800-594-5736
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/16/2006
Last Update Date : 09/24/2007

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