Basic Information
| Provider Information | |||||||||
| NPI: | 1053396416 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GERARDY | ||||||||
| FirstName: | SCOTT | ||||||||
| MiddleName: | A. | ||||||||
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| Credential: | CRNA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2204 HOFFMAN DR | ||||||||
| Address2: | STE A | ||||||||
| City: | LOVELAND | ||||||||
| State: | CO | ||||||||
| PostalCode: | 80538 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9706679794 | ||||||||
| FaxNumber: | 9706636336 | ||||||||
| Practice Location | |||||||||
| Address1: | 2000 BOISE AVE | ||||||||
| Address2: | |||||||||
| City: | LOVELAND | ||||||||
| State: | CO | ||||||||
| PostalCode: | 805385006 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9706694640 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/08/2005 | ||||||||
| LastUpdateDate: | 01/10/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | 2002000772 | MO | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered | 367500000X | 55040 | KS | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered | 367500000X | 102713 | CO | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
ID Information
| ID | Type | State | Issuer | Description | 915798102 | 05 | MO | MEDICAID | 100417600A | 05 | KS | MEDICAID | 86505530 | 05 | CO | MEDICAID |