Provider Demographics
NPI:1346299393
Name:BENDORF, RICK D (CRNA)
Entity Type:Individual
Prefix:
First Name:RICK
Middle Name:D
Last Name:BENDORF
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 1:250 NE MULBERRY ST
Mailing Address - Street 2:C/O SJS MEDICAL MANAGEMENT
Mailing Address - City:LEES SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:64086-4533
Mailing Address - Country:US
Mailing Address - Phone:816-389-4130
Mailing Address - Fax:816-389-4140
Practice Address - Street 1:250 NE MULBERRY ST
Practice Address - Street 2:C/O SJS MEDICAL MANAGEMENT
Practice Address - City:LEES SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:64086-4533
Practice Address - Country:US
Practice Address - Phone:816-389-4130
Practice Address - Fax:816-389-4140
Is Sole Proprietor?:No
Enumeration Date:2006-05-08
Last Update Date:2022-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO086951367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO916815616Medicaid
AANAOther044585
MOP00258037Medicare PIN
MO916815616Medicaid
MO430079915Medicare UPIN
MOJ116163Medicare PIN
AANAOther044585
MO826525236Medicare PIN