Provider Demographics
NPI:1053396416
Name:GERARDY, SCOTT A (CRNA)
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:A
Last Name:GERARDY
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2204 HOFFMAN DR
Mailing Address - Street 2:STE A
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80538
Mailing Address - Country:US
Mailing Address - Phone:970-667-9794
Mailing Address - Fax:970-663-6336
Practice Address - Street 1:2000 BOISE AVE
Practice Address - Street 2:
Practice Address - City:LOVELAND
Practice Address - State:CO
Practice Address - Zip Code:80538-5006
Practice Address - Country:US
Practice Address - Phone:970-669-4640
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-08
Last Update Date:2012-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2002000772367500000X
KS55040367500000X
CO102713367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO915798102Medicaid
KS100417600AMedicaid
CO86505530Medicaid
COCOAAA1973Medicare UPIN
CO806917Medicare ID - Type Unspecified
MOP54451Medicare UPIN
MO915798102Medicaid