Basic Information
| Provider Information | |||||||||
| NPI: | 1063563682 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HOHLBEIN | ||||||||
| FirstName: | LEONARD | ||||||||
| MiddleName: | JOHN | ||||||||
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| Credential: | CRNA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1008 W STATE LINE ST | ||||||||
| Address2: | |||||||||
| City: | FULTON | ||||||||
| State: | KY | ||||||||
| PostalCode: | 420411263 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5736865550 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2000 HOLIDAY LN | ||||||||
| Address2: | |||||||||
| City: | FULTON | ||||||||
| State: | KY | ||||||||
| PostalCode: | 420418468 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2704722522 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/12/2007 | ||||||||
| LastUpdateDate: | 02/09/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | 1050627 | KY | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
ID Information
| ID | Type | State | Issuer | Description | 430029060 | 01 | KY | RAILROAD MEDICARE | OTHER | 000000053397 | 01 | KY | KY BCBS | OTHER | 3002798 | 01 | TN | TN BCBS | OTHER | 74903915 | 05 | KY | MEDICAID | 4600035 | 05 | TN | MEDICAID |