Provider Demographics
NPI:1225096308
Name:COX, KERMIT (CRNA)
Entity Type:Individual
Prefix:
First Name:KERMIT
Middle Name:
Last Name:COX
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 1:100 E LEFEVRE RD
Mailing Address - Street 2:
Mailing Address - City:STERLING
Mailing Address - State:IL
Mailing Address - Zip Code:61081-1278
Mailing Address - Country:US
Mailing Address - Phone:618-443-2177
Mailing Address - Fax:
Practice Address - Street 1:SPARTA COMMUNITY HOSPITAL
Practice Address - Street 2:818 EAST BROADWAY
Practice Address - City:SPARTA
Practice Address - State:IL
Practice Address - Zip Code:62286
Practice Address - Country:US
Practice Address - Phone:618-443-2177
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-01
Last Update Date:2017-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041147219367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
S38267Medicare UPIN