1720159544 NPI number — MR. MICHAEL STEPHEN ARNOLD CRNA

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720159544 NPI number — MR. MICHAEL STEPHEN ARNOLD CRNA

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

ARNOLD

Provider First Name:

MICHAEL

Provider Middle Name:

STEPHEN

Provider Name Prefix Text:

MR.

Provider Name Suffix Text:

Provider Credential Text:

CRNA

Provider Gender Code:

M

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:

1720159544

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

01/24/2022

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

300 E MCBEE AVE FL 4

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:

GREENVILLE

Provider Business Mailing Address State Name:

SC

Provider Business Mailing Address Postal Code:

29601-2842

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

Provider Business Mailing Address Fax Number:

478-745-4849

Provider First Line Business Practice Location Address:

380 HOSPITAL DR

Provider Second Line Business Practice Location Address:

SUITE 410

Provider Business Practice Location Address City Name:

MACON

Provider Business Practice Location Address State Name:

GA

Provider Business Practice Location Address Postal Code:

31217

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

478-746-5644

Provider Business Practice Location Address Fax Number:

478-633-4908

Provider Enumeration Date:

11/13/2006

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 367500000X , with the licence number:  RN053794 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 367500000X , with the licence number: APN0000009033 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 367500000X , with the licence number: RN053794 CRNA , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 367500000X , with the licence number: 22969 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 000764244P , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
• Identifier: 000764244R , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
• Identifier: 580628385 . This is a "TRICARE" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
• Identifier: P01044804 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
• Identifier: 000764244T , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
• Identifier: AN2969 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
• Identifier: 000764244S , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".