Provider Demographics
NPI:1700898657
Name:RAABE, SCOTT J (CRNA)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:J
Last Name:RAABE
Suffix:
Gender:M
Credentials:CRNA
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Mailing Address - Street 1:1325 S CLIFF AVE
Mailing Address - Street 2:PO BOX 5045 ATTN: PT FINANCIAL SERVICES
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57105-1007
Mailing Address - Country:US
Mailing Address - Phone:605-322-6400
Mailing Address - Fax:605-322-6499
Practice Address - Street 1:1325 S CLIFF AVE
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57105-1007
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:2012-05-24
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Provider Licenses
StateLicense IDTaxonomies
SDR030947-0599367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
1700898657OtherWELLMARK BCBS TRICARE - AVERA FLANDREAU HOSPITAL
MN171613100Medicaid
SD5754730Medicaid
IA1700898657Medicaid
SDR030947OtherDAKOTACARE
SD0100212OtherSD BLUE CROSS PROV #
MN174P1RAOtherMN BLUE CROSS PROV #
NE460224743-48Medicaid
SD0100212OtherSD BLUE CROSS PROV #
1700898657OtherWELLMARK BCBS TRICARE - AVERA FLANDREAU HOSPITAL
IA1700898657Medicaid