1831293547 NPI number — RODNEY K MCFADDEN CRNA

Table of content: RODNEY K MCFADDEN CRNA (NPI 1831293547)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831293547 NPI number — RODNEY K MCFADDEN CRNA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MCFADDEN
Provider First Name:
RODNEY
Provider Middle Name:
K
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:
1831293547
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/03/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3616 E SHEFFIELD WAY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SPRINGFIELD
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
65802-2466
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3616 E SHEFFIELD WAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SPRINGFIELD
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
65802-2466
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
417-848-0191
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/12/2006

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:  065906 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 912808052 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 125331701 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1831293547 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 20174319965616B006 . This is a "TRICARE" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 100786870B , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 194111 . This is a "BCBS" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 5277 . This is a "COX HEALTH" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 401097 . This is a "HEALTHLINK" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: P00267912 . This is a "RAILROAD" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".




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