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NPI Code Detail

MEDICARE: THEODORE FRANK COLLIER CRNA

MEDICARE: THEODORE FRANK COLLIER 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 Anesthetist2001004740MO

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1609977677
Entity Type Code : Individual
Provider Name (Legal Business Name) : THEODORE FRANK COLLIER CRNA
Provider Business Mailing Address
First Line : PO BOX 4046
Second Line :
City : SPRINGFIELD
State : MO
Zip : 65808-4046
Country : US
Telephone Number : 417-269-5712
Fax Number : 417-269-7567
Provider Business Practice Location Address
First Line : 801 N LINCOLN AVE
Second Line :
City : MONETT
State : MO
Zip : 65708-1641
Country : US
Telephone Number : 417-235-3144
Fax Number : 417-354-1412
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/25/2006
Last Update Date : 10/28/2019

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Directions to “ THEODORE FRANK COLLIER CRNA” Practice Location

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