1134100118 NPI number — ROBERT D KINDER CRNA

Employer Identification Number (EIN)	:
Provider Organization Name (Legal Business Name)	:
Provider Last Name (Legal Name)	:	KINDER
Provider First Name	:	ROBERT
Provider Middle Name	:	D
Provider Name Prefix Text	:
Provider Name Suffix Text	:
Provider Credential Text	:	CRNA
Provider Gender Code	:	M

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Provider Other First Name	:
Provider Other Middle Name	:
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NPI Number	:	1134100118
Entity Type Code	:	Individual
Replacement NPI	:
Last Update Date	:	07/25/2008
NPI Deactivation Reason Code	:
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Provider First Line Business Mailing Address	:	13523 BARRETT PARKWAY DR
Provider Second Line Business Mailing Address	:	SUITE 210
Provider Business Mailing Address City Name	:	BALLWIN
Provider Business Mailing Address State Name	:	MO
Provider Business Mailing Address Postal Code	:	630213802
Provider Business Mailing Address Country Code	:	US
Provider Business Mailing Address Telephone Number	:	3147752816
Provider Business Mailing Address Fax Number	:	3147752821

Provider First Line Business Practice Location Address	:	300 1ST CAPITOL DR
Provider Second Line Business Practice Location Address	:
Provider Business Practice Location Address City Name	:	SAINT CHARLES
Provider Business Practice Location Address State Name	:	MO
Provider Business Practice Location Address Postal Code	:	633012844
Provider Business Practice Location Address Country Code	:	US
Provider Business Practice Location Address Telephone Number	:	3149893000
Provider Business Practice Location Address Fax Number	:
Provider Enumeration Date	:	11/08/2005

Authorized Official Last Name	:
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• Taxonomy code: 367500000X , with the licence number:  154030 , registered in the state of MO .

• Identifier: P00335028 . This is a "RR MEDICARE" identifier , issued by the state of ( MO ) . This identifiers is of the category "".
• Identifier: 814770276 , issued by the state of ( MO ) . This identifiers is of the category "".
• Identifier: 918401514 , issued by the state of ( MO ) . This identifiers is of the category "".