Provider Demographics
NPI:1720052897
Name:MINGA, DAVID E (CRNA)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:E
Last Name:MINGA
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 1:740 E LAUREL RD
Mailing Address - Street 2:
Mailing Address - City:LONDON
Mailing Address - State:KY
Mailing Address - Zip Code:40741-8601
Mailing Address - Country:US
Mailing Address - Phone:606-877-3931
Mailing Address - Fax:606-877-3978
Practice Address - Street 1:310 E 9TH ST
Practice Address - Street 2:
Practice Address - City:LONDON
Practice Address - State:KY
Practice Address - Zip Code:40741-1204
Practice Address - Country:US
Practice Address - Phone:606-878-6520
Practice Address - Fax:606-877-3978
Is Sole Proprietor?:No
Enumeration Date:2006-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1953A367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYC20887OtherCUMBERLAND HEALTHCARE INC
KYP00335909OtherRRMCR
KY74422999Medicaid
KY000000378007OtherANTHEM PROVIDER #
KY50005621OtherPASSPORT HEALTH PLAN
KY50005621OtherPASSPORT HEALTH PLAN
KYR82980Medicare UPIN