Cruise, Grover Scott

Cruise, Grover Scott is an sole proprietor health care provider with primary practice located at 125 S 12Th Ave , Hattiesburg MS 39401-6106. He recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Nurse Anesthetist, Certified Registered, which is considered as his primary health care specialty. Cruise, Grover Scott can be contacted via phone (601) 310-4509.

Contact Information

Primary practice address
125 S 12Th Ave Hattiesburg MS 39401-6106
Phone: (601) 310-4509
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Nurse Anesthetist, Certified Registered 367500000X R847413 Mississippi

Profile Details

NPI number 1720043219
LBN Legal business name Cruise, Grover Scott
Credentials Certified Registered Nurse Anesthetist (CRNA)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Apr 19th, 2006
Last updated Oct 17th, 2017 - about 9 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1720043219 NPPES
Mississippi MEDICAID 00121803
Mississippi MEDICAID 2116461

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