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NPI Code Detail

MEDICARE: MARK E RUFF CRNA

MEDICARE: MARK E RUFF 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 Anesthetist209000515IL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1038222OTHERCCNA CERTIFICATION
2041199920OTHERILRN LICENSE

General Provider Information

NPI Number : 1871555284
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARK E RUFF CRNA
Provider Business Mailing Address
First Line : 800 E CARPENTER ST
Second Line :
City : SPRINGFIELD
State : IL
Zip : 62769-1000
Country : US
Telephone Number : 217-544-6464
Fax Number : 217-757-6537
Provider Business Practice Location Address
First Line : 800 E CARPENTER ST
Second Line :
City : SPRINGFIELD
State : IL
Zip : 62769-1000
Country : US
Telephone Number : 217-544-6464
Fax Number : 217-757-6537
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/03/2006
Last Update Date : 01/04/2022

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