Provider Demographics
NPI:1043334188
Name:MICHAEL R. ROCHIN CRNA MS
Entity Type:Organization
Organization Name:MICHAEL R. ROCHIN CRNA MS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF CRNA
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:ROCHIN
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:325-947-6616
Mailing Address - Street 1:3520 KNICKERBOCKER RD
Mailing Address - Street 2:SUITE B #313
Mailing Address - City:SAN ANGELO
Mailing Address - State:TX
Mailing Address - Zip Code:76904-7611
Mailing Address - Country:US
Mailing Address - Phone:325-947-6616
Mailing Address - Fax:325-692-6030
Practice Address - Street 1:3501 KNICKERBOCKER RD
Practice Address - Street 2:
Practice Address - City:SAN ANGELO
Practice Address - State:TX
Practice Address - Zip Code:76904-7610
Practice Address - Country:US
Practice Address - Phone:325-947-6616
Practice Address - Fax:325-692-6030
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-16
Last Update Date:2008-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX538940367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1634065-01Medicaid
TX0012LCOtherBLUE CROSS BLUESHIELD
TX1634065-01Medicaid