Provider Demographics
NPI:1538134671
Name:ZOSS, PATRICK A (CRNA)
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:A
Last Name:ZOSS
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 1:42668 263RD ST
Mailing Address - Street 2:
Mailing Address - City:EMERY
Mailing Address - State:SD
Mailing Address - Zip Code:57332
Mailing Address - Country:US
Mailing Address - Phone:605-449-4925
Mailing Address - Fax:605-449-4925
Practice Address - Street 1:42668 263RD ST
Practice Address - Street 2:
Practice Address - City:EMERY
Practice Address - State:SD
Practice Address - Zip Code:57332
Practice Address - Country:US
Practice Address - Phone:605-449-4925
Practice Address - Fax:605-449-4925
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-22
Last Update Date:2007-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD0543367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD5753120Medicaid
SDS40688Medicare PIN
SD40688Medicare ID - Type Unspecified