Provider Demographics
NPI:1952492977
Name:HEDGES, CALVIN (CRNA)
Entity Type:Individual
Prefix:MR
First Name:CALVIN
Middle Name:
Last Name:HEDGES
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 CEDAR COVE LN
Mailing Address - Street 2:
Mailing Address - City:EDDYVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42038-8708
Mailing Address - Country:US
Mailing Address - Phone:270-625-5296
Mailing Address - Fax:
Practice Address - Street 1:225 MEDICAL CENTER DR
Practice Address - Street 2:
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42003-7914
Practice Address - Country:US
Practice Address - Phone:270-441-4500
Practice Address - Fax:270-441-4289
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2014-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3001722367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY74422502Medicaid
KYK143080Medicare PIN