1417078197 NPI number — DR. BARTLETT A STONE ANESTHESIOLOGIST

Table of content: DR. BARTLETT A STONE ANESTHESIOLOGIST (NPI 1417078197)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417078197 NPI number — DR. BARTLETT A STONE ANESTHESIOLOGIST

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
STONE
Provider First Name:
BARTLETT
Provider Middle Name:
A
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
ANESTHESIOLOGIST
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1417078197
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/09/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 515
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BARBOURSVILLE
Provider Business Mailing Address State Name:
WV
Provider Business Mailing Address Postal Code:
25504-0515
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
304-736-6126
Provider Business Mailing Address Fax Number:
304-736-1531

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2900 1ST AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HUNTINGTON
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
25702-1241
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-736-6126
Provider Business Practice Location Address Fax Number:
304-736-1531
Provider Enumeration Date:
04/02/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  16557 , registered in the state of WV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 001721137 . This is a "WV BLUE CROSS" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: 0059738000 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 550696369-00 . This is a "WV WORKERS COMP" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".