Basic Information
| Provider Information | |||||||||
| NPI: | 1043334188 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MICHAEL R. ROCHIN CRNA MS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3520 KNICKERBOCKER RD | ||||||||
| Address2: | SUITE B #313 | ||||||||
| City: | SAN ANGELO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 769047611 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3259476616 | ||||||||
| FaxNumber: | 3256926030 | ||||||||
| Practice Location | |||||||||
| Address1: | 3501 KNICKERBOCKER RD | ||||||||
| Address2: | |||||||||
| City: | SAN ANGELO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 769047610 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3259476616 | ||||||||
| FaxNumber: | 3256926030 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/16/2007 | ||||||||
| LastUpdateDate: | 06/13/2008 | ||||||||
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| AuthorizedOfficialLastName: | ROCHIN | ||||||||
| AuthorizedOfficialFirstName: | MICHAEL | ||||||||
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| AuthorizedOfficialTitleorPosition: | CHIEF CRNA | ||||||||
| AuthorizedOfficialTelephone: | 3259476616 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| AuthorizedOfficialCredential: | CRNA | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | 538940 | TX | Y | 193400000X SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
ID Information
| ID | Type | State | Issuer | Description | 1634065-01 | 05 | TX | MEDICAID | 0012LC | 01 | TX | BLUE CROSS BLUESHIELD | OTHER |