| Lonnie W Clark, CRNA | |
|
16420 W Us Highway 24, Woodland Park, CO 80863-8760 | |
| (806) 790-3928 | |
| Not Available |
| Full Name | Lonnie W Clark |
|---|---|
| Gender | Male |
| Speciality | Certified Registered Nurse Anesthetist (crna) |
| Experience | 21 Years |
| Location | 16420 W Us Highway 24, Woodland Park, Colorado |
| Accepts Medicare Assignments | May be. He may accept the Medicare-approved amount; you may be billed for more than the Medicare deductible and coinsurance. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1598777450 | NPI | - | NPPES |
| 179419001 | Medicaid | TX | |
| 200073510A | Medicaid | OK | |
| 90739868 | Medicaid | CO | |
| 67349 | Medicaid | TX | |
| 147825100 | Medicaid | TX | |
| 202004266 | Medicaid | NM | |
| 147825101 | Other | TX | FIRSTCARE COMMERCIAL |
| 86092U | Other | TX | BC/BS |
| 202004266 | Other | NM | PRESBYTERIAN COMMERCIAL |
| 86091U | Other | TX | HMO BLUE |
| 64851729 | Medicaid | NM |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 367500000X | Nurse Anesthetist, Certified Registered | 690859 (Texas) | Primary |
| Facility Name | Location | Facility Type |
|---|---|---|
| Uchealth Pikes Peak Regional Hospital | Woodland park, CO | Hospital |
| Entity Name | Woodland Park Anesthesia Llc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1417249996 PECOS PAC ID: 3971771999 Enrollment ID: O20110719000292 |
| Entity Name | Diehl Anesthesia Inc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1467833897 PECOS PAC ID: 6800197575 Enrollment ID: O20151229000111 |
| Mailing Address | Practice Location Address |
|---|---|
| Lonnie W Clark, CRNA 420 Paisley Dr, Colorado Springs, CO 80906-8205 Ph: (806) 790-3928 | Lonnie W Clark, CRNA 16420 W Us Highway 24, Woodland Park, CO 80863-8760 Ph: (806) 790-3928 |
Mr. Brian Thomas Farstad, CRNA Nurse Anesthetist - CR Medicare: Medicare Enrolled Practice Location: 16420 W Us Highway 24, Pikes Peak Regional Hospital, Woodland Park, CO 80863 Phone: 607-207-7233 | |
Ryan Bezzant, CRNA Nurse Anesthetist - CR Medicare: Accepting Medicare Assignments Practice Location: 16420 W Us Highway 24, Woodland Park, CO 80863 Phone: 719-374-6060 |