Provider Demographics
NPI:1679596233
Name:OLDS, ROBERT G (CRNA)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:G
Last Name:OLDS
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 1:4211 TROLLEY LINE RD
Mailing Address - Street 2:
Mailing Address - City:AIKEN
Mailing Address - State:SC
Mailing Address - Zip Code:29801-2749
Mailing Address - Country:US
Mailing Address - Phone:803-648-2840
Mailing Address - Fax:
Practice Address - Street 1:4211 TROLLEY LINE RD
Practice Address - Street 2:
Practice Address - City:AIKEN
Practice Address - State:SC
Practice Address - Zip Code:29801-2749
Practice Address - Country:US
Practice Address - Phone:803-648-2840
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2010-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCCRNA80823367500000X
SC80823163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCAN0938Medicaid
SCQ323042461Medicare PIN
SCQ323047136Medicare PIN
SCAN0938Medicaid