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NPI Code Detail

MEDICARE: KELLY D LOMAX CRNA

MEDICARE: KELLY D LOMAX 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 AnesthetistCRNA1367AZ

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
24072322OTHERTNBCBS NUMBER
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1730180639
Entity Type Code : Individual
Provider Name (Legal Business Name) : KELLY D LOMAX CRNA
Provider Business Mailing Address
First Line : 1850 N CENTRAL AVE
Second Line : STE 1600
City : PHOENIX
State : AZ
Zip : 85004-4633
Country : US
Telephone Number : 615-327-4304
Fax Number : 615-327-7940
Provider Business Practice Location Address
First Line : 13400 E SHEA BLVD
Second Line :
City : SCOTTSDALE
State : AZ
Zip : 85259-5452
Country : US
Telephone Number : 480-301-8000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/02/2005
Last Update Date : 07/21/2022

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