Healthcare Provider Details

I. General information

NPI: 1144280470
Provider Name (Legal Business Name): CHARLES M HAGEDORN CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/23/2006
Last Update Date: 10/22/2025
Certification Date: 10/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 E 14TH ST
SEDALIA MO
65301-5972
US

IV. Provider business mailing address

22432 DOC RHODES DR
WARSAW MO
65355-6931
US

V. Phone/Fax

Practice location:
  • Phone: 660-829-7744
  • Fax: 660-827-7678
Mailing address:
  • Phone: 402-245-8446
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number100561
License Number StateNE
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number2006032655
License Number StateMO
# 3
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number55374
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: