1538569504 NPI number — MR. DUSTIN T. ARNOLD CRNA

Table of content: MR. DUSTIN T. ARNOLD CRNA (NPI 1538569504)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538569504 NPI number — MR. DUSTIN T. ARNOLD CRNA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ARNOLD
Provider First Name:
DUSTIN
Provider Middle Name:
T.
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
CRNA
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1538569504
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/20/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5151 REED RD
Provider Second Line Business Mailing Address:
SUITE 225-C
Provider Business Mailing Address City Name:
COLUMBUS
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43220-2595
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
614-884-0641
Provider Business Mailing Address Fax Number:
614-884-0776

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5151 REED RD
Provider Second Line Business Practice Location Address:
SUITE 225-C
Provider Business Practice Location Address City Name:
COLUMBUS
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43220-2595
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
614-884-0641
Provider Business Practice Location Address Fax Number:
614-884-0776
Provider Enumeration Date:
08/27/2014

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 367500000X , with the licence number:  RN357832 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: P01380990 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 0110215 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




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