MEDICARE: DONALD RUCH 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	3192	CA
2	367500000X	Certified Registered Nurse Anesthetist	RN126254	GA

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

General Provider Information

NPI Number	:	1871575191
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DONALD RUCH CRNA

Provider Business Mailing Address
First Line	:	93 TREE LN
Second Line	:
City	:	HARTWELL
State	:	GA
Zip	:	30643-9231
Country	:	US
Telephone Number	:	706-376-3686
Fax Number	:

Provider Business Practice Location Address
First Line	:	93 TREE LN
Second Line	:
City	:	HARTWELL
State	:	GA
Zip	:	30643-9231
Country	:	US
Telephone Number	:	706-376-3686
Fax Number	:

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

Provider Enumeration Date	:	11/14/2005
Last Update Date	:	03/04/2013

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