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NPI Code Detail

MEDICARE: ROBERT V CARRILLO CRNA

MEDICARE: ROBERT V CARRILLO CRNA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1367500000XCertified Registered Nurse Anesthetist54133KS

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1145207OTHERKSBLUE CROSS, PC

General Provider Information

NPI Number : 1508879305
Entity Type Code : Individual
Provider Name (Legal Business Name) : ROBERT V CARRILLO CRNA
Provider Business Mailing Address
First Line : 401 WOODLAND HILLS BLVD
Second Line :
City : FORT SCOTT
State : KS
Zip : 66701-8797
Country : US
Telephone Number : 620-223-2200
Fax Number :
Provider Business Practice Location Address
First Line : 401 WOODLAND HILLS BLVD
Second Line :
City : FORT SCOTT
State : KS
Zip : 66701-8797
Country : US
Telephone Number : 620-223-2200
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/14/2006
Last Update Date : 07/09/2007

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