| Dirk Bradley Bahoravitch, MSN, CRNA | |
|
1067 N 500 W, Provo, UT 84604-3305 | |
| (801) 374-0354 | |
| Not Available |
| Full Name | Dirk Bradley Bahoravitch |
|---|---|
| Gender | Male |
| Speciality | Nurse Anesthetist, Certified Registered |
| Location | 1067 N 500 W, Provo, Utah |
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1184083826 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 367500000X | Nurse Anesthetist, Certified Registered | 53485 (Idaho) | Primary |
| Entity Name | Radius Anesthesia Of New Mexico Llc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1376092403 PECOS PAC ID: 1153672159 Enrollment ID: O20181001000769 |
| Entity Name | Main Street Anesthesia Of New Mexico, Llc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1275010985 PECOS PAC ID: 3476807538 Enrollment ID: O20181108002622 |
| Mailing Address | Practice Location Address |
|---|---|
| Dirk Bradley Bahoravitch, MSN, CRNA 264 N 1020 E, American Fork, UT 84003-2957 Ph: (801) 592-5424 | Dirk Bradley Bahoravitch, MSN, CRNA 1067 N 500 W, Provo, UT 84604-3305 Ph: (801) 374-0354 |
Sarah Ward Barnaby, CRNA Nurse Anesthetist - CR Medicare: Accepting Medicare Assignments Practice Location: 1034 N 500 W, Provo, UT 84604 Phone: 801-727-2056 Fax: 770-701-6675 | |
Rodney L Fisher, CRNA Nurse Anesthetist - CR Medicare: Not Enrolled in Medicare Practice Location: 320 River Park Dr Ste 125, Provo, UT 84604 Phone: 801-375-8049 Fax: 801-374-9195 | |
Chase Bazil, CRNA Nurse Anesthetist - CR Medicare: Not Enrolled in Medicare Practice Location: 1900 N State St Ste 105, Provo, UT 84604 Phone: 801-655-5245 | |
Shelby Lyn Beck, Nurse Anesthetist - CR Medicare: Accepting Medicare Assignments Practice Location: 1067 N 500 W, Provo, UT 84604 Phone: 801-374-0354 | |
Joyce Westphal, CRNA Nurse Anesthetist - CR Medicare: Not Enrolled in Medicare Practice Location: 585 N 500 W, Provo, UT 84601 Phone: 801-375-0983 Fax: 801-375-0988 | |
Samantha Anderson, Nurse Anesthetist - CR Medicare: Accepting Medicare Assignments Practice Location: 1034 N 500 W, Provo, UT 84604 Phone: 608-695-0168 |