Provider Demographics
NPI:1073542213
Name:M. ATCHISON CRNA INC, A PROFESSIONAL NURSING CORP.
Entity Type:Organization
Organization Name:M. ATCHISON CRNA INC, A PROFESSIONAL NURSING CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MELVIN
Authorized Official - Middle Name:A
Authorized Official - Last Name:ATCHISON
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:866-640-3005
Mailing Address - Street 1:PO BOX 6139
Mailing Address - Street 2:
Mailing Address - City:NAPA
Mailing Address - State:CA
Mailing Address - Zip Code:94581-1139
Mailing Address - Country:US
Mailing Address - Phone:888-270-0340
Mailing Address - Fax:888-270-0331
Practice Address - Street 1:1000 TRANCAS ST
Practice Address - Street 2:QUEEN OF THE VALLEY HOSPITAL
Practice Address - City:NAPA
Practice Address - State:CA
Practice Address - Zip Code:94558
Practice Address - Country:US
Practice Address - Phone:707-228-2901
Practice Address - Fax:707-256-3508
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-01
Last Update Date:2014-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1156367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CARN4194710Medicaid
CARN4194710Medicaid
CAR20842Medicare UPIN