Provider Demographics
NPI:1255372579
Name:HAGER, JOHN H (CRNA)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:H
Last Name:HAGER
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:222 HILLSIDE DR
Mailing Address - Street 2:
Mailing Address - City:NITRO
Mailing Address - State:WV
Mailing Address - Zip Code:25143-2328
Mailing Address - Country:US
Mailing Address - Phone:304-346-9400
Mailing Address - Fax:904-494-6467
Practice Address - Street 1:220 HILLSIDE DR
Practice Address - Street 2:
Practice Address - City:NITRO
Practice Address - State:WV
Practice Address - Zip Code:25143-2328
Practice Address - Country:US
Practice Address - Phone:304-346-9400
Practice Address - Fax:904-494-6467
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2014-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV020899367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV8225773Medicare PIN
WV27005299700OtherBRICKSTREET
WVDA0096OtherRR MEDICARE
WV0065039000Medicaid
WV8225773Medicare PIN
WV001706470OtherMSBCBS
WV9333201Medicare PIN
WV270052997006OtherTRICARE
WVP00001153OtherRR MEDICARE
WV0207026000Medicaid