Individual
MR. MICHAEL C MCCONNELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
1407 UNION AVE, SUITE 200, MEMPHIS, TN 38104-3600
(901) 866-8813
(901) 302-2120
Mailing address
1407 UNION AVE, SUITE 640, MEMPHIS, TN 38104-3627
(901) 866-8360
(901) 302-2360
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
9302
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0116747
MEDICAID W/MAA
MS
01
—
136280701
MEDICAID W/MAA
AR
01
—
3607660
MEDICAID W/MAA
TN
01
—
3607663
MEDICARE W/MAA
TN
05
—
3607664
—
TN
01
—
4010460
BLUE CROSS W/MAA
TN
01
—
430056979
RAILROAD MEDICARE W/MAA
TN
01
—
915066112
MEDICAID W/MAA
MO
01
—
98469
BLUE CROSS W/MAA
AR
Enumeration date
05/01/2006
Last updated
06/09/2011
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