Provider Demographics
NPI:1598777195
Name:SCHROEDER, ALAN R (CRNA)
Entity Type:Individual
Prefix:
First Name:ALAN
Middle Name:R
Last Name:SCHROEDER
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 1:800 E 21ST ST
Mailing Address - Street 2:PO BOX 5045, ATTN: P.F.S.
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:2006-08-12
Last Update Date:2010-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDR018088-0177367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0574822Medicaid
SD460224743-57105-AC06OtherTRICARE PROV #
SDR018088OtherDAKOTACARE PROV #
SD5752013Medicaid
SD0065166OtherSD BLUE CROSS PROV #
MN050K7SCOtherMN BLUE CROSS PROV #
MN354243200Medicaid
NE46022474348Medicaid
SD0065166OtherSD BLUE CROSS PROV #
SD430024394Medicare PIN