Organization
MARION COUNTY ANESTHESIA LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. RICHARD C JOHNSON (CRNA/MEMBER)
(843) 431-2542
Entity
Organization
Contact information
Practice address
2829 E HIGHWAY 76, MULLINS, SC 29574-6035
(843) 431-2542
Mailing address
PO BOX 1547, SEDALIA, MO 65302-1547
(660) 826-5960
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
DN4700
RR MEDICARE
SC
05
—
GP0097
—
SC
Enumeration date
01/04/2008
Last updated
09/08/2011
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