1235235961 NPI number — ASSOCIATION OF ANESTHESIA PROVIDERS, LLC

Table of content: (NPI 1235235961)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235235961 NPI number — ASSOCIATION OF ANESTHESIA PROVIDERS, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ASSOCIATION OF ANESTHESIA PROVIDERS, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1235235961
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/08/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1009
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHARLESTON
Provider Business Mailing Address State Name:
WV
Provider Business Mailing Address Postal Code:
25324-1009
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
304-346-9400
Provider Business Mailing Address Fax Number:
304-345-7320

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1325 LOCUST AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FAIRMONT
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
26554-1435
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-346-9400
Provider Business Practice Location Address Fax Number:
304-345-7320
Provider Enumeration Date:
09/16/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BOGGESS
Authorized Official First Name:
MARSHA
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
304-346-9400

Provider Taxonomy Codes

  • Taxonomy code: 207L00000X , with the licence number:  16058 , 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: 612330401 . This is a "FEDERAL BLACK LUNG" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: 001907643 . This is a "BCBS MD 'PAY TO'" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: 612330400 . This is a "FECA" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: DF0767 . This is a "RR MEDICARE" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: 3810006746 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 001907661 . This is a "BCBS CRNA 'PAY TO' NUMBER" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: 1070905 . This is a "BRICKSTREET" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".




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