Provider Demographics
NPI:1780699488
Name:MEINEN, ROGER W (CRNA)
Entity type:Individual
Prefix:MR
First Name:ROGER
Middle Name:W
Last Name:MEINEN
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:307 WALNUT ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:YANKTON
Mailing Address - State:SD
Mailing Address - Zip Code:57078-4361
Mailing Address - Country:US
Mailing Address - Phone:605-664-5050
Mailing Address - Fax:605-664-5051
Practice Address - Street 1:2601 FOX RUN PKWY
Practice Address - Street 2:
Practice Address - City:YANKTON
Practice Address - State:SD
Practice Address - Zip Code:57078-5341
Practice Address - Country:US
Practice Address - Phone:605-664-5050
Practice Address - Fax:605-664-5051
Is Sole Proprietor?:No
Enumeration Date:2006-07-30
Last Update Date:2008-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDR014067163W00000X
SD021848367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE020584922Medicaid
SD35254OtherMIDLANDS CHOICE
SD4993763OtherBLUE CROSS BLUE SHIELD
SD5750832Medicaid
SD9220266OtherDAKOTACARE
SDP00435823OtherRAILROAD
SD9220266OtherDAKOTACARE