Provider Demographics
NPI:1467450312
Name:MOSCHEL, SCOTT (CRNA)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:
Last Name:MOSCHEL
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 1:11490 SPRINGFIELD PIKE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45246-3524
Mailing Address - Country:US
Mailing Address - Phone:513-672-3309
Mailing Address - Fax:513-672-3323
Practice Address - Street 1:10500 MONTGOMERY RD
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45242-4402
Practice Address - Country:US
Practice Address - Phone:513-672-3309
Practice Address - Fax:513-672-3323
Is Sole Proprietor?:No
Enumeration Date:2005-07-13
Last Update Date:2018-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH269834163W00000X
IN28216927A367500000X
OH054905367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000965298OtherANTHEM PROVIDER NUMBER
IN200457630Medicaid
KY74010703Medicaid
000000380302OtherANTHEM
OH2437572Medicaid
IN815500100Medicare PIN
OHMO8231621Medicare ID - Type Unspecified
OHM08231624Medicare PIN
IN000000965298OtherANTHEM PROVIDER NUMBER