Basic Information
Provider Information | |||||||||
NPI: | 1023003852 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | BARTEK | ||||||||
FirstName: | CHRISTOPHER | ||||||||
MiddleName: | M | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | CRNA | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 4500 W 69TH ST | ||||||||
Address2: |   | ||||||||
City: | SIOUX FALLS | ||||||||
State: | SD | ||||||||
PostalCode: | 571088148 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6059777000 | ||||||||
FaxNumber: | 6059777001 | ||||||||
Practice Location | |||||||||
Address1: | 4500 W 69TH ST | ||||||||
Address2: |   | ||||||||
City: | SIOUX FALLS | ||||||||
State: | SD | ||||||||
PostalCode: | 571088148 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6059777000 | ||||||||
FaxNumber: | 6059777001 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 09/19/2005 | ||||||||
LastUpdateDate: | 01/09/2015 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | R027905 | SD | Y |   | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |   |
ID Information
ID | Type | State | Issuer | Description | 1023003852 | 05 | IA |   | MEDICAID | 46022474348 | 05 | NE |   | MEDICAID | 4994856 | 01 | SD | WELLMARK | OTHER | 5754163 | 05 | SD |   | MEDICAID | 0592055 | 05 | IA |   | MEDICAID | 4992834 | 01 | SD | BLUE CROSS OF SD | OTHER | R027905 | 01 |   | DAKOTACARE | OTHER | 689451800 | 05 | MN |   | MEDICAID | 75L17BA | 01 | MN | MN BLUECROSS BS | OTHER | 5754162 | 05 | SD |   | MEDICAID |