Provider Demographics
NPI:1992703839
Name:HILL, LARRY R (CRNA)
Entity type:Individual
Prefix:MR
First Name:LARRY
Middle Name:R
Last Name:HILL
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 1:227 BARTON AVE
Mailing Address - Street 2:
Mailing Address - City:TERRE HAUTE
Mailing Address - State:IN
Mailing Address - Zip Code:47803-1839
Mailing Address - Country:US
Mailing Address - Phone:812-234-8652
Mailing Address - Fax:
Practice Address - Street 1:7 MEADOWS SHOPPING CTR
Practice Address - Street 2:
Practice Address - City:TERRE HAUTE
Practice Address - State:IN
Practice Address - Zip Code:47803-2373
Practice Address - Country:US
Practice Address - Phone:812-237-0211
Practice Address - Fax:812-237-0182
Is Sole Proprietor?:No
Enumeration Date:2005-07-13
Last Update Date:2010-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28147059A367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200280720AMedicaid
IN200280720AMedicaid
IN258290CMedicare PIN
INR64664Medicare UPIN