Provider Demographics
NPI:1386704526
Name:ZACHARY, RICHARD A (CRNA)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:A
Last Name:ZACHARY
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 11225
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37401-2225
Mailing Address - Country:US
Mailing Address - Phone:423-892-5602
Mailing Address - Fax:423-892-5838
Practice Address - Street 1:975 E. THIRD ST
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37403-2147
Practice Address - Country:US
Practice Address - Phone:423-778-7608
Practice Address - Fax:423-778-2360
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2010-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNRN44615163W00000X
GARN072321163W00000X
TNAPN08952367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3040273OtherBLUE CROSS BLUE SHIELD TN
GA000573658AMedicaid
TN1513892Medicaid
NC8052517Medicaid
AL009710030Medicaid
GAN362329OtherWELLCARE (GA MEDICAID)
TN430030834OtherRAILROAD MEDICARE
TN3040273OtherBLUE CROSS BLUE SHIELD TN