Provider Demographics
NPI:1285677864
Name:RIEGER, TODD (CRNA)
Entity Type:Individual
Prefix:
First Name:TODD
Middle Name:
Last Name:RIEGER
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:PO BOX 2897
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67201-2897
Mailing Address - Country:US
Mailing Address - Phone:800-374-5326
Mailing Address - Fax:800-374-7656
Practice Address - Street 1:929 N SAINT FRANCIS ST
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67214-3821
Practice Address - Country:US
Practice Address - Phone:800-374-5326
Practice Address - Fax:800-374-7656
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2008-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS55453367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS145230OtherBCBS OF KS
P00278241OtherRR MEDICARE GROUP CQ2303
KS145230Medicare PIN
KS145230Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER