MEDICARE: KENNETH LOGAN GRIFFITH C.R.N.A.

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	R139828	MD
2	367500000X	Certified Registered Nurse Anesthetist	TLRN060830	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	R139828	OTHER	MD	STATE LICENSE
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1861494387
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KENNETH LOGAN GRIFFITH C.R.N.A.

Provider Business Mailing Address
First Line	:	3421 CONCORD RD
Second Line	:
City	:	YORK
State	:	PA
Zip	:	17402-9001
Country	:	US
Telephone Number	:	717-741-8250
Fax Number	:	717-741-8289

Provider Business Practice Location Address
First Line	:	25 MONUMENT RD STE 270
Second Line	:
City	:	YORK
State	:	PA
Zip	:	17403-5073
Country	:	US
Telephone Number	:	717-741-8250
Fax Number	:	717-741-8289

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

Provider Enumeration Date	:	08/15/2005
Last Update Date	:	01/27/2021

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Directions to “ KENNETH LOGAN GRIFFITH C.R.N.A.” Practice Location

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