MEDICARE: CROSS COUNTRY ANESTHESIA, INC.

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	050966	OH

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	00216277	OTHER	OH	RAILROAD MEDICARE

General Provider Information

NPI Number	:	1700920469
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CROSS COUNTRY ANESTHESIA, INC.

Provider Business Mailing Address
First Line	:	2533 DERBYSHIRE RD
Second Line	:
City	:	CLEVELAND HTS
State	:	OH
Zip	:	44106-3230
Country	:	US
Telephone Number	:	216-932-4522
Fax Number	:	216-928-0141

Provider Business Practice Location Address
First Line	:	2533 DERBYSHIRE RD
Second Line	:
City	:	CLEVELAND HTS
State	:	OH
Zip	:	44106-3230
Country	:	US
Telephone Number	:	216-932-4522
Fax Number	:	216-928-0141

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. LINCOLN DANIEL GISEL
Credential	:	CRNA
Telephone Number	:	216-932-4522

Provider Enumeration Date	:	02/16/2007
Last Update Date	:	08/22/2020

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