MEDICARE: MR. KEITH LOYD COPELAND 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	236533	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
5	P00379468	OTHER	TX	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	031051	OTHER	TX	RECERTIFICATION AANA
2	86923U	OTHER	TX	BLUE CROSS BLUE SHIELD
3	81740U	OTHER	TX	BLUE CROSS BLUE SHIELD
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	031051	OTHER		CRNA

General Provider Information

NPI Number	:	1962497263
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. KEITH LOYD COPELAND CRNA

Provider Business Mailing Address
First Line	:	PO BOX 4346
Second Line	:	DEPT 398
City	:	HOUSTON
State	:	TX
Zip	:	77210-4346
Country	:	US
Telephone Number	:	281-358-8114
Fax Number	:	281-358-0609

Provider Business Practice Location Address
First Line	:	4120 SOUTHWEST FWY
Second Line	:	SUITE 100
City	:	HOUSTON
State	:	TX
Zip	:	77027-7339
Country	:	US
Telephone Number	:	713-626-8500
Fax Number	:	713-626-8560

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

Provider Enumeration Date	:	09/13/2005
Last Update Date	:	02/27/2008

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