MEDICARE: CHRIS FOX LLC

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	9189197	FL

General Provider Information

NPI Number	:	1881964120
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHRIS FOX LLC

Provider Business Mailing Address
First Line	:	7 HOLLY HILL RD
Second Line	:
City	:	DOTHAN
State	:	AL
Zip	:	36305-1150
Country	:	US
Telephone Number	:	334-702-3302
Fax Number	:

Provider Business Practice Location Address
First Line	:	2915 MADISON ST
Second Line	:
City	:	MARIANNA
State	:	FL
Zip	:	32446-3449
Country	:	US
Telephone Number	:	850-536-2460
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	CHRIS S FOX
Credential	:	CRNA
Telephone Number	:	334-702-3302

Provider Enumeration Date	:	01/04/2012
Last Update Date	:	11/02/2012

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