Laird Ian Clark, CRNA
Individual provider Active NPI Certified Registered Nurse Anesthetist · Moab, UT
NPI 1811289416 · NPPES record last updated Oct 24, 2019
Key facts
- NPI
- 1811289416
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Certified Registered Nurse Anesthetist 367500000X
- License
- 361242-4406 (UT)
- Practice address
- 450 Williams Way
Moab, UT 84532-2185 - Phone
- (435) 719-3510
- NPI assigned
- May 15, 2011
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 4
Hospital & facility affiliations 2
Medicare Care Compare profile
- Specialty
- Certified Registered Nurse Anesthetist (Crna)
- Education
- Other, 2011
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Animas Anesthesia Associates LLC
Moab Valley Healthcare, Inc.
Practice addresses (Care Compare)
2 Burnett CT
Durango, CO 81301-3647
Phone (970) 385-4022
450 Williams Way
Moab, UT 84532-2185
Phone (435) 719-3500
Hospital & facility affiliations
- Moab Regional Hospital
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in UT, CO
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20150529001839 | UT | Practitioner - Certified Registered Nurse Anesthetist (Crna) | 0648445767 | Reassigns benefits to 2 organizations |
| I20260319003127 | CO | Practitioner - Certified Registered Nurse Anesthetist (Crna) | 0648445767 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Certified Registered Nurse
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 361242-4406 | UT | MD | Certified Registered Nurse Anesthetist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Animas Anesthesia Associates LLC | Current |
Accepting new patients | |
| Moab Valley Healthcare, Inc. | Current |
Accepting new patients |
Locations
2 Burnett Ct
Durango, CO 81301
Phone (970) 385-4022
2 Burnett Ct
Ste 200
Durango, CO 81301
Phone (970) 247-3537
450 W Williams Way
Moab, UT 84532
Phone (435) 259-7191
476 W Williams Way
Moab, UT 84532
Phone (435) 719-3500
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Certified Registered Nurse Anesthetist | 367500000X | 361242-4406 | UT | Yes |
Addresses
Primary practice location
450 Williams Way
Moab, UT 84532-2185
Mailing address
450 Williams Way
Moab, UT 84532-2185
Phone (435) 719-3510
Other providers in Moab, UT
- Kelly Caylor
- Tammy Marie Chapman
- Lorynn Charlton
- Olga Chesson
- Sophia Cinnamon
- Jessica Cloward
- Dylan Cole
- Daniel Cook I
- Koi Derrick Cook
- Paula Jane Cook
All providers in Moab, UT · Certified Registered Nurse Anesthetist in Utah
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 24, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.