Provider Demographics
NPI:1831133578
Name:CRUSE, ROGER V II (CRNA)
Entity Type:Individual
Prefix:
First Name:ROGER
Middle Name:V
Last Name:CRUSE
Suffix:II
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 1:200 HOSPITAL DR
Mailing Address - Street 2:
Mailing Address - City:SPENCER
Mailing Address - State:WV
Mailing Address - Zip Code:25276-1050
Mailing Address - Country:US
Mailing Address - Phone:304-927-4444
Mailing Address - Fax:304-927-6837
Practice Address - Street 1:200 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:SPENCER
Practice Address - State:WV
Practice Address - Zip Code:25276-1050
Practice Address - Country:US
Practice Address - Phone:304-927-6372
Practice Address - Fax:304-927-6390
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-15
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CRNA.08297367500000X
WV116450367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2541137Medicaid
OH2541137Medicaid
OHP00837676OtherRRMCR
OH000000505201OtherANTHEM
OH000000642878OtherANTHEM
WV3810001809Medicaid
P00243484OtherMEDICARE RAILROAD
OH2541137Medicaid
WV3810001809Medicaid