MEDICARE: REST EASY CRNA SERVICES, 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	3024	SC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	196585	OTHER	SC	MEDCOST
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1982742581
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	REST EASY CRNA SERVICES, LLC

Provider Business Mailing Address
First Line	:	PO BOX 100523
Second Line	:
City	:	FLORENCE
State	:	SC
Zip	:	29501-0523
Country	:	US
Telephone Number	:	843-669-5162
Fax Number	:	843-667-4573

Provider Business Practice Location Address
First Line	:	101 SURGEONS DR
Second Line	:
City	:	MYRTLE BEACH
State	:	SC
Zip	:	29579-5198
Country	:	US
Telephone Number	:	843-669-5162
Fax Number	:	843-667-4573

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	SHARON G. COTTON
Credential	:	CRNA
Telephone Number	:	843-902-0143

Provider Enumeration Date	:	02/03/2007
Last Update Date	:	04/20/2008

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