MEDICARE: MR. MARK A HORNSBY 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	NA2773	CA
2	367500000X	Certified Registered Nurse Anesthetist	AP112316	TX

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	86896U	OTHER	TX	BCBSTX
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	1D4636	OTHER	TX	NOVITAS - 855I
5	1D4636	OTHER	TX	855R

General Provider Information

NPI Number	:	1881653079
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MARK A HORNSBY CRNA

Provider Business Mailing Address
First Line	:	PO BOX 1130
Second Line	:
City	:	DENVER CITY
State	:	TX
Zip	:	79323-1130
Country	:	US
Telephone Number	:	806-592-2121
Fax Number	:	806-592-5489

Provider Business Practice Location Address
First Line	:	412 MUSTANG DR
Second Line	:
City	:	DENVER CITY
State	:	TX
Zip	:	79323-2762
Country	:	US
Telephone Number	:	806-592-2121
Fax Number	:	806-592-5489

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

Provider Enumeration Date	:	03/17/2006
Last Update Date	:	06/23/2020

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