Provider Demographics
NPI:1053615526
Name:RODRIGUEZ, LUIS B (CRNA)
Entity type:Individual
Prefix:
First Name:LUIS
Middle Name:B
Last Name:RODRIGUEZ
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 1:2801 LEVI DR
Mailing Address - Street 2:
Mailing Address - City:ARKANSAS CITY
Mailing Address - State:KS
Mailing Address - Zip Code:67005-4127
Mailing Address - Country:US
Mailing Address - Phone:610-703-8695
Mailing Address - Fax:
Practice Address - Street 1:2801 LEVI DR
Practice Address - Street 2:
Practice Address - City:ARKANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:67005-4127
Practice Address - Country:US
Practice Address - Phone:610-703-8695
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-12-27
Last Update Date:2024-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS14-151453-011163W00000X
OK212552367500000X
KS43-557766-011367500000X
FLAPRN11025817367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA3821024000OtherIND. BLUE CROSS
PA1594393OtherGATEWAY
PA2571791OtherFIRST PRIORITY
PA12186828OtherCAQH
PA1027798060001Medicaid
PA146167OtherGEISINGER
PA2571791OtherHIGHMARK
PA50097984OtherCAPITAL ADVANTGE
PA9685655OtherAETNA
PAP00918486Medicare PIN
PA208324QCYMedicare PIN