Provider Demographics
NPI:1629128509
Name:COX, LUKE I (CRNA)
Entity Type:Individual
Prefix:
First Name:LUKE
Middle Name:I
Last Name:COX
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 1:425 N BELMONT AVE
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67208-3810
Mailing Address - Country:US
Mailing Address - Phone:316-304-6635
Mailing Address - Fax:
Practice Address - Street 1:600 MEDICAL CENTER DRIVE
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:KS
Practice Address - Zip Code:67114
Practice Address - Country:US
Practice Address - Phone:316-283-2700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-11
Last Update Date:2015-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS55556367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200419350AMedicaid
KS55556OtherRNA LICENSE
P00398949OtherRR MEDICARE GROUP CQ2302
KS145403OtherBCBS OF KS
KS200419350AMedicaid