Provider Demographics
NPI:1578574760
Name:MEYERS, MITCHELL L (CRNA)
Entity Type:Individual
Prefix:
First Name:MITCHELL
Middle Name:L
Last Name:MEYERS
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:MITCH
Other - Middle Name:L
Other - Last Name:MEYERS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CRNA
Mailing Address - Street 1:800 E 21ST ST
Mailing Address - Street 2:PAT FINANCIAL SERVICES
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57105-1016
Mailing Address - Country:US
Mailing Address - Phone:605-322-2754
Mailing Address - Fax:605-322-2727
Practice Address - Street 1:800 E 21ST ST
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57105-1016
Practice Address - Country:US
Practice Address - Phone:605-322-2754
Practice Address - Fax:605-322-2727
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2010-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDR028586-0538367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0574707Medicaid
SD0041113OtherSD BLUE CROSS PROV #
SD5753770Medicaid
SC9219612OtherDAKOTACARE PROVIDER #
NE46022474348Medicaid
MN211967600Medicaid
SD460224743-57105-AC04OtherTRICARE PROVIDER #
MN050K6MEOtherMN BLUE CROSS PROV #
MN211967600Medicaid
SD460224743-57105-AC04OtherTRICARE PROVIDER #