Basic Information
| Provider Information | |||||||||
| NPI: | 1336178755 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CACCAMO | ||||||||
| FirstName: | LINDA | ||||||||
| MiddleName: | ANN | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | CRNA | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | SMACK | ||||||||
| OtherFirstName: | LINDA | ||||||||
| OtherMiddleName: | ANN | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 100 WITMER RD | ||||||||
| Address2: | STE 220 | ||||||||
| City: | HORSHAM | ||||||||
| State: | PA | ||||||||
| PostalCode: | 190442279 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2154425000 | ||||||||
| FaxNumber: | 2159572875 | ||||||||
| Practice Location | |||||||||
| Address1: | 250 S 21ST ST | ||||||||
| Address2: | |||||||||
| City: | EASTON | ||||||||
| State: | PA | ||||||||
| PostalCode: | 180423851 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6102504300 | ||||||||
| FaxNumber: | 6102504804 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/30/2006 | ||||||||
| LastUpdateDate: | 08/31/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | L1-0017904 | DE | N | Nursing Service Providers | Registered Nurse | 163W00000X | 041399722 | IL | N | Nursing Service Providers | Registered Nurse | 367500000X | L6-0A00150 | DE | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered | 367500000X | 209009608 | IL | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered | 367500000X | RN1035967 | DC | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered | 367500000X | 4704282528 | MI | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered | 367500000X | RN620353 | PA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
ID Information
| ID | Type | State | Issuer | Description | 102681818 | 05 | PA | MEDICAID | P00962403 | 01 | PA | RAILROAD MEDICARE | OTHER | 193850801 | 05 | TX | MEDICAID | 89164U | 01 | TX | BCBS | OTHER |