| Cody Lee Haerther, | |
|
664 Greer Ave, Nixa, MO 65714-7637 | |
| (818) 421-0683 | |
| Not Available |
| Full Name | Cody Lee Haerther |
|---|---|
| Gender | Male |
| Speciality | Nurse Anesthetist, Certified Registered |
| Location | 664 Greer Ave, Nixa, Missouri |
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1417682238 | NPI | - | NPPES |
| 910125759 | Medicaid | MO |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 367500000X | Nurse Anesthetist, Certified Registered | 144380 (Missouri) | Primary |
| Entity Name | Mercy Clinic Springfield Communities |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1972771657 PECOS PAC ID: 7416865845 Enrollment ID: O20031218000354 |
| Entity Name | Mercy St Francis Hospital |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1023053477 PECOS PAC ID: 7810806643 Enrollment ID: O20040120000229 |
| Entity Name | Mercy St Francis Hospital |
|---|---|
| Entity Type | Part A Provider - Critical Access Hospital |
| Entity Identifiers | NPI Number: 1023053477 PECOS PAC ID: 7810806643 Enrollment ID: O20061104000139 |
| Entity Name | Lester E Cox Medical Centers |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1174952212 PECOS PAC ID: 1658509864 Enrollment ID: O20140115001602 |
| Mailing Address | Practice Location Address |
|---|---|
| Cody Lee Haerther, Po Box 802843, Kansas City, MO 64180-2843 Ph: () - | Cody Lee Haerther, 664 Greer Ave, Nixa, MO 65714-7637 Ph: (818) 421-0683 |
Marie Kathryn Rostic, CRNA Nurse Anesthetist - CR Medicare: Not Enrolled in Medicare Practice Location: 674 North Greer, Nixa, MO 65714 Phone: 417-459-7219 |