1780691410 NPI number — KENNETH J KRAUSHAR CRNA

Table of content: KENNETH J KRAUSHAR CRNA (NPI 1780691410)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780691410 NPI number — KENNETH J KRAUSHAR CRNA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KRAUSHAR
Provider First Name:
KENNETH
Provider Middle Name:
J
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:
1780691410
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/09/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
13611 NORTHUMBERLAND CIR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WELLINGTON
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33414-8931
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
561-333-9079
Provider Business Mailing Address Fax Number:
561-333-0634

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
13611 NORTHUMBERLAND CIR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WELLINGTON
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33414-8931
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
561-333-9079
Provider Business Practice Location Address Fax Number:
561-333-0634
Provider Enumeration Date:
08/02/2006

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:  ARNP3361762 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 300994700 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: G2573 . This is a "BCBS OF FLORIDA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 104947400 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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