MEDICARE: MICHAEL C LOOMIS 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
1	367500000X	Certified Registered Nurse Anesthetist	RN254017L	PA
2	163W00000X	Registered Nurse	RN-254017-L	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	1553210	OTHER	PA	GATEWAY
4	11803037	OTHER	PA	CAQH
5	76114	OTHER	PA	GEISINGER
6	50014783	OTHER	PA	CAPITAL ADVANTAGE
7	7951477	OTHER	PA	AETNA
8	1406648	OTHER	PA	HIGHMARK
9	2094350000	OTHER	PA	IBC
10	1406648	OTHER	PA	FIRST PRIORITY

General Provider Information

NPI Number	:	1811993769
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL C LOOMIS CRNA

Provider Business Mailing Address
First Line	:	7918 MAIN ST
Second Line	:	SUITE 204
City	:	FOGELSVILLE
State	:	PA
Zip	:	18051-1744
Country	:	US
Telephone Number	:	610-366-9536
Fax Number	:	610-366-9538

Provider Business Practice Location Address
First Line	:	7918 MAIN STREET
Second Line	:	SUITE 204
City	:	FOGELSVILLE
State	:	PA
Zip	:	18051-0488
Country	:	US
Telephone Number	:	610-366-9536
Fax Number	:	610-366-9538

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/24/2005
Last Update Date	:	03/25/2013

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