1043238405 NPI number — STEVEN GASPER CRNA

Table of content: STEVEN GASPER CRNA (NPI 1043238405)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043238405 NPI number — STEVEN GASPER CRNA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GASPER
Provider First Name:
STEVEN
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CRNA
Provider Gender Code:
M

Provider's Other Name Information

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 Information

NPI Number:
1043238405
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/17/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9945 N 64TH AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MERRILL
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
54452-7507
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
715-675-4162
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
601 S CENTER AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MERRILL
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
54452-3404
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
715-539-5136
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/17/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 367500000X , with the licence number:  142133030 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 002721305 . This is a "MEDICARE HUMANA GOLD" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".
  • Identifier: 391330887 . This is a "ASSOCIATES FOR HEALTHCARE" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".
  • Identifier: 80335 . This is a "SECURITY HEALTH PLAN" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".
  • Identifier: 80335 . This is a "SECURITY HEALTH MEDICAID" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".
  • Identifier: GASPER . This is a "WPS" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".
  • Identifier: 430075365 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".
  • Identifier: 391330887 . This is a "HEALTH EOS" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".
  • Identifier: 44315500 . This is a "MANAGED HEALTH CARE" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".
  • Identifier: 44315500 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".




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