Basic Information
| Provider Information | |||||||||
| NPI: | 1124020060 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KOHUT | ||||||||
| FirstName: | ROBERT | ||||||||
| MiddleName: | LOUIS | ||||||||
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| Credential: | CRNA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 406 WESTPORT CIR | ||||||||
| Address2: | |||||||||
| City: | PITTSTON | ||||||||
| State: | PA | ||||||||
| PostalCode: | 186403229 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5708832228 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1200 S CEDAR CREST BLVD | ||||||||
| Address2: | |||||||||
| City: | ALLENTOWN | ||||||||
| State: | PA | ||||||||
| PostalCode: | 181036202 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6104029099 | ||||||||
| FaxNumber: | 6104029029 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/11/2005 | ||||||||
| LastUpdateDate: | 10/11/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/11/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | RN509304-L | PA | N | Nursing Service Providers | Registered Nurse | 367500000X | 858778 | NY | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered | 367500000X | RN509304L | PA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
ID Information
| ID | Type | State | Issuer | Description | 03223501 | 01 | PA | CAPITAL ADVANTAGE | OTHER | 1345043 | 01 | PA | HIGHMARK | OTHER | 0073989170002 | 05 | PA | MEDICAID | 11776579 | 01 | PA | CAQH | OTHER | 2037603000 | 01 | PA | IBC | OTHER | 50922 | 01 | PA | GEISINGER | OTHER | 1345043 | 01 | PA | FIRST PRIORITY | OTHER | 9213458 | 01 | PA | AETNA | OTHER | 1548332 | 01 | PA | GATEWAY | OTHER |