Provider Demographics
NPI:1477632123
Name:MCEACHEN, ROBERT W (CRNA)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:W
Last Name:MCEACHEN
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 1:7537 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64114-1124
Mailing Address - Country:US
Mailing Address - Phone:816-786-8158
Mailing Address - Fax:
Practice Address - Street 1:10310 STATE LINE RD STE A
Practice Address - Street 2:ST JOSEPH ANESTHESIA SERVICES
Practice Address - City:LEAWOOD
Practice Address - State:KS
Practice Address - Zip Code:66206-2695
Practice Address - Country:US
Practice Address - Phone:913-647-4101
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-03
Last Update Date:2022-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO144284367500000X
KS55371367500000X
KS1375832091163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSD59D209Medicare ID - Type Unspecified