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NPI Code Detail

MEDICARE: MR. JOHN S MCGLOTHLEN CRNA

MEDICARE: MR. JOHN S MCGLOTHLEN 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
1174400000XSpecialistR0031880OK

General Provider Information

NPI Number : 1790777563
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. JOHN S MCGLOTHLEN CRNA
Provider Business Mailing Address
First Line : 937 N COWBOY CANYON DR
Second Line :
City : GREEN VALLEY
State : AZ
Zip : 85614-5546
Country : US
Telephone Number : 520-398-7481
Fax Number :
Provider Business Practice Location Address
First Line : 1200 E PECAN ST
Second Line :
City : ALTUS
State : OK
Zip : 73521-6141
Country : US
Telephone Number : 580-477-7243
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/18/2005
Last Update Date : 07/08/2007

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