1518948264 NPI number — GREENWOOD ANESTHESIA & PAIN MGMT, PLLC

Table of content: (NPI 1518948264)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518948264 NPI number — GREENWOOD ANESTHESIA & PAIN MGMT, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GREENWOOD ANESTHESIA & PAIN MGMT, PLLC
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:
1518948264
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/27/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
29 CREAMERY LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EASTON
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21601-3137
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-222-1335
Provider Business Mailing Address Fax Number:
410-819-0712

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1401 RIVER RD
Provider Second Line Business Practice Location Address:
ANESTHESIA DEPARTMENT
Provider Business Practice Location Address City Name:
GREENWOOD
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
38930-4030
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
662-459-7000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/09/2005

Additional Information

Authorized Official

Authorized Official Last Name:
BESSELIEVRE
Authorized Official First Name:
TODD
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
800-222-1335

Provider Taxonomy Codes

  • Taxonomy code: 207L00000X , with the licence number:  16017 , registered in the state of MS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 08074314 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".




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