=====================================================
General NPI Number Information
=====================================================
NPI Number | 1407939796
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | RONALD KYLE HODGEN CRNA
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/23/2006
-----------------------------------------------------
Last Update Date | 08/30/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5700 GATEWAY STE 100B
-----------------------------------------------------
City | MASON
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45040-1890
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 513-404-4529
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5700 GATEWAY STE 100B
-----------------------------------------------------
City | MASON
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45040-1890
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 367500000X
-----------------------------------------------------
Taxonomy Name | Certified Registered Nurse Anesthetist
-----------------------------------------------------
License Number | 9281942
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 367500000X
-----------------------------------------------------
Taxonomy Name | Certified Registered Nurse Anesthetist
-----------------------------------------------------
License Number | APRN.CRNA.019367
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------