Provider Demographics
NPI:1962478396
Name:SIMS, KEITH S (CRNA)
Entity Type:Individual
Prefix:
First Name:KEITH
Middle Name:S
Last Name:SIMS
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:KEITH
Other - Middle Name:
Other - Last Name:SZYMANSKI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:510 DEPOT ST APT 200
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29201-2272
Mailing Address - Country:US
Mailing Address - Phone:803-509-4056
Mailing Address - Fax:
Practice Address - Street 1:MEDICAL PARK #8
Practice Address - Street 2:#200
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29203
Practice Address - Country:US
Practice Address - Phone:803-296-2548
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-25
Last Update Date:2013-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP2604032367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCS19541Medicare UPIN