Healthcare Provider Details

I. General information

NPI: 1477632123
Provider Name (Legal Business Name): ROBERT W MCEACHEN CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/03/2006
Last Update Date: 10/13/2022
Certification Date: 10/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10310 STATE LINE RD STE A ST JOSEPH ANESTHESIA SERVICES
LEAWOOD KS
66206-2695
US

IV. Provider business mailing address

7537 MAIN ST
KANSAS CITY MO
64114-1124
US

V. Phone/Fax

Practice location:
  • Phone: 913-647-4101
  • Fax:
Mailing address:
  • Phone: 816-786-8158
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number144284
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number55371
License Number StateKS
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number1375832091
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: