Basic Information
| Provider Information | |||||||||
| NPI: | 1427186949 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SMALL | ||||||||
| FirstName: | SUSANNE | ||||||||
| MiddleName: | K. | ||||||||
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| Credential: | C.R.N.A. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1188 | ||||||||
| Address2: | |||||||||
| City: | MADISONVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 424315009 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2708243682 | ||||||||
| FaxNumber: | 2708243675 | ||||||||
| Practice Location | |||||||||
| Address1: | 900 HOSPITAL DR | ||||||||
| Address2: | |||||||||
| City: | MADISONVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 424311644 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2708243682 | ||||||||
| FaxNumber: | 2708243675 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/28/2007 | ||||||||
| LastUpdateDate: | 08/24/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | 137090 | MO | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
ID Information
| ID | Type | State | Issuer | Description | P00944104 | 01 | KY | MEDICARE RAILROAD FOR 5363 | OTHER | 8298 | 01 | MO | HEALTHCARE USA (GROUP) | OTHER | 0563130 | 05 | IA | MEDICAID | 430079704 | 01 | RAILROAD MEDICARE | OTHER | 915942007 | 05 | MO | MEDICAID | 80172 | 01 | MO | HEALTHCARE USA | OTHER | CG4336 | 01 | RAILROAD MEDICARE | OTHER | 0976845 | 05 | IA | MEDICAID |