1952341026 NPI number — CURTIS C KRUEGER CRNA

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952341026 NPI number — CURTIS C KRUEGER CRNA

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

KRUEGER

Provider First Name:

CURTIS

Provider Middle Name:

C

Provider Name Prefix Text:

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:

1952341026

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

02/22/2019

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

2401 DEMERS AVE

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:

GRAND FORKS

Provider Business Mailing Address State Name:

ND

Provider Business Mailing Address Postal Code:

58201

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

701-780-1891

Provider Business Mailing Address Fax Number:

218-686-2595

Provider First Line Business Practice Location Address:

1200 S COLUMBIA RD - ALTRU HOSPITAL

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:

GRAND FORKS

Provider Business Practice Location Address State Name:

ND

Provider Business Practice Location Address Postal Code:

58201

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

701-780-6000

Provider Business Practice Location Address Fax Number:

218-686-2595

Provider Enumeration Date:

06/07/2006

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:  R153023-6 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 367500000X , with the licence number: R21652 , registered in the state of ND ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 1042684 . This is a "PREFERRED ONE #" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
• Identifier: 127878900 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
• Identifier: 138H8KR . This is a "MNBCBS #" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
• Identifier: 56110 . This is a "LHS-BANNER HEALTH #" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
• Identifier: HP45236 . This is a "HEALTHPARTNERS #" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
• Identifier: 12721 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
• Identifier: 133876 . This is a "UCARE #" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
• Identifier: 2003641 . This is a "MEDICA #" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
• Identifier: 27901 . This is a "NDBCBS #" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
• Identifier: R153023-6 . This is a "MN LICENSE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".