Individual
MICHAEL C LOOMIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
7918 MAIN STREET, SUITE 204, FOGELSVILLE, PA 18051-0488
(610) 366-9536
(610) 366-9538
Mailing address
7918 MAIN ST, SUITE 204, FOGELSVILLE, PA 18051-1744
(610) 366-9536
(610) 366-9538
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
RN-254017-L
PA
367500000X
Certified Registered Nurse Anesthetist
Primary
RN254017L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0019709940001
—
PA
05
—
0019709940003
—
PA
01
—
11803037
CAQH
PA
01
—
1406648
HIGHMARK
PA
01
—
1553210
GATEWAY
PA
01
—
2094350000
IBC
PA
01
—
50014783
CAPITAL ADVANTAGE
PA
01
—
76114
GEISINGER
PA
01
—
7951477
AETNA
PA
Enumeration date
06/24/2005
Last updated
03/25/2013
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