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NPI Code Detail

MEDICARE: KENT KOSMATKA C.R.N.A.

MEDICARE: KENT KOSMATKA C.R.N.A.
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 Anesthetist209000291IL
2367500000XCertified Registered Nurse Anesthetist26167SC

General Provider Information

NPI Number : 1891771770
Entity Type Code : Individual
Provider Name (Legal Business Name) : KENT KOSMATKA C.R.N.A.
Provider Business Mailing Address
First Line : PO BOX 503256
Second Line :
City : SAINT LOUIS
State : MO
Zip : 63150-0001
Country : US
Telephone Number : 660-826-5960
Fax Number : 660-826-4852
Provider Business Practice Location Address
First Line : 3333 W DEYOUNG ST
Second Line :
City : MARION
State : IL
Zip : 62959-5884
Country : US
Telephone Number : 660-826-5960
Fax Number : 660-826-4852
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/21/2005
Last Update Date : 01/17/2025

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Directions to “ KENT KOSMATKA C.R.N.A.” Practice Location

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