MEDICARE: JOSEPH A FORREST 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	RN0000056894	TN

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

General Provider Information

NPI Number	:	1962404715
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSEPH A FORREST CRNA

Provider Business Mailing Address
First Line	:	730 SHADDEN RD
Second Line	:
City	:	GRAY
State	:	TN
Zip	:	37615
Country	:	US
Telephone Number	:	423-753-2653
Fax Number	:

Provider Business Practice Location Address
First Line	:	1 MEDICAL PARK BLVD
Second Line	:
City	:	BRISTOL
State	:	TN
Zip	:	37620-7430
Country	:	US
Telephone Number	:	423-968-4540
Fax Number	:	423-968-5697

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

Provider Enumeration Date	:	08/11/2005
Last Update Date	:	07/08/2007

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Directions to “ JOSEPH A FORREST CRNA” Practice Location

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