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NPI Code Detail

MEDICARE: SCOTT C GENTRY CRNA

MEDICARE: SCOTT C GENTRY 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 AnesthetistC01200AR

General Provider Information

NPI Number : 1952386633
Entity Type Code : Individual
Provider Name (Legal Business Name) : SCOTT C GENTRY CRNA
Provider Business Mailing Address
First Line : PO BOX 1547
Second Line :
City : SEDALIA
State : MO
Zip : 65302-1547
Country : US
Telephone Number : 660-826-5960
Fax Number : 660-826-4852
Provider Business Practice Location Address
First Line : 1801 MARTIN LUTHER KING JR DR
Second Line :
City : HELENA
State : AR
Zip : 72342-8998
Country : US
Telephone Number : 870-338-5800
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/14/2005
Last Update Date : 07/08/2007

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Directions to “ SCOTT C GENTRY CRNA” Practice Location

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