Provider Demographics
NPI:1598862120
Name:CALDWELL, JASON W (CRNA)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:W
Last Name:CALDWELL
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 713350
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-1392
Mailing Address - Country:US
Mailing Address - Phone:502-588-9490
Mailing Address - Fax:502-272-5116
Practice Address - Street 1:231 E CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-1821
Practice Address - Country:US
Practice Address - Phone:502-629-6000
Practice Address - Fax:502-451-4553
Is Sole Proprietor?:No
Enumeration Date:2006-09-17
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3004381367500000X
KY4381A367500000X
IN28172150A367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000346373OtherBCBS PROVIDER NUMBER
KY4381AOtherLICENSE
IN223090POtherMEDICARE FGTBA REASSIGN
IN200857600Medicaid
KY74008517Medicaid
IN514023OtherANTHEM/BCBS
KYP00145778Medicare PIN
IN223090POtherMEDICARE FGTBA REASSIGN
KY4381AOtherLICENSE