Provider Demographics
NPI:1437158995
Name:BODE, THOMAS LEE (CRNA)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:LEE
Last Name:BODE
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 PARKWAY DR
Mailing Address - Street 2:
Mailing Address - City:PALM COAST
Mailing Address - State:FL
Mailing Address - Zip Code:32164-2801
Mailing Address - Country:US
Mailing Address - Phone:606-209-3186
Mailing Address - Fax:
Practice Address - Street 1:27 PARKWAY DR
Practice Address - Street 2:
Practice Address - City:PALM COAST
Practice Address - State:FL
Practice Address - Zip Code:32164-2801
Practice Address - Country:US
Practice Address - Phone:606-209-3186
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-18
Last Update Date:2016-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP 9211289367500000X, 367500000X
ME044891367500000X
MI4704119431367500000X
CA2661367500000X
NVCRNA 238367500000X
GARN170155 CRNA367500000X
SCAPN2014367500000X
AL1-098206367500000X
NC194158367500000X
VA0001188713367500000X
TX690273367500000X
AZRN127027367500000X
OHRN177639367500000X
KY802A367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2341817Medicaid
IN200510690Medicaid
KY74010687Medicaid
FLG3836AOtherMARTIN COUNTY ANESTHESIA
KY4-0029230OtherRAILROAD MEDICARE
000000356339OtherANTHEM
KY74010687Medicaid
R62123Medicare UPIN
KY74010687Medicaid
KY0918159Medicare PIN
KY3321599Medicare ID - Type UnspecifiedMC PROVIDER #