Basic Information
| Provider Information | |||||||||
| NPI: | 1629396098 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | LANCASTER HOSPITAL CORPORATION | ||||||||
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| OtherOrganizationName: | SPRINGS MEMORIAL HOSPITAL CRNA GROUP | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1547 | ||||||||
| Address2: | |||||||||
| City: | SEDALIA | ||||||||
| State: | MO | ||||||||
| PostalCode: | 653021547 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6608265960 | ||||||||
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| Practice Location | |||||||||
| Address1: | 800 W MEETING ST | ||||||||
| Address2: | |||||||||
| City: | LANCASTER | ||||||||
| State: | SC | ||||||||
| PostalCode: | 297202202 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8032861214 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/11/2010 | ||||||||
| LastUpdateDate: | 10/19/2011 | ||||||||
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| AuthorizedOfficialLastName: | CRABDREE | ||||||||
| AuthorizedOfficialFirstName: | NATHAN | ||||||||
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| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 8032861481 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | Y | 193400000X SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
ID Information
| ID | Type | State | Issuer | Description | GP5420 | 05 | SC | MEDICAID | DR0718 | 01 | SC | RR MEDICARE | OTHER | 8053837 | 05 | NC | MEDICAID |