Provider Demographics
NPI:1770530511
Name:CALLAHAN, BRIAN (CRNA)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:
Last Name:CALLAHAN
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 1:800 E 21ST ST
Mailing Address - Street 2:PO BOX 5045
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57105-1016
Mailing Address - Country:US
Mailing Address - Phone:605-322-2754
Mailing Address - Fax:605-322-2727
Practice Address - Street 1:800 E 21ST ST
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57105-1016
Practice Address - Country:US
Practice Address - Phone:605-322-6400
Practice Address - Fax:605-322-6499
Is Sole Proprietor?:No
Enumeration Date:2006-05-27
Last Update Date:2009-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR1561137367500000X
SDSD-CRNA CR000688367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
9265185OtherDAKOTACARE
1770530511OtherBCBS MN
NE46022474348Medicaid
1770530511OtherWELLMARK BCBS-SD
SD5755900Medicaid
SDS102493Medicare PIN
9265185OtherDAKOTACARE
SD5755900Medicaid