Individual
JASON W CALDWELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
2990 GOTTBRATH PKWY, JEFFERSONVILLE, IN 47130-8901
(812) 671-0990
Mailing address
PO BOX 713350, CHICAGO, IL 60677-1392
(502) 588-9490
(502) 272-5116
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
28172150A
IN
367500000X
Certified Registered Nurse Anesthetist
Primary
3004381
KY
367500000X
Certified Registered Nurse Anesthetist
4381A
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000346373
BCBS PROVIDER NUMBER
—
05
—
200857600
—
IN
01
—
223090P
MEDICARE FGTBA REASSIGN
IN
01
—
4381A
LICENSE
KY
01
—
514023
ANTHEM/BCBS
IN
05
—
74008517
—
KY
Enumeration date
09/17/2006
Last updated
01/27/2025
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