1578648663 NPI number — ELSA F WEST CRNA

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578648663 NPI number — ELSA F WEST CRNA

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

WEST

Provider First Name:

ELSA

Provider Middle Name:

F

Provider Name Prefix Text:

Provider Name Suffix Text:

Provider Credential Text:

CRNA

Provider Gender Code:

F

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:

1578648663

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

05/19/2008

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

PO BOX 711841

Provider Second Line Business Mailing Address:

MID ATLANTIC ANESTHESIA CONSULTANTS

Provider Business Mailing Address City Name:

COLUMBUS

Provider Business Mailing Address State Name:

OH

Provider Business Mailing Address Postal Code:

43271-0001

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

304-346-9400

Provider Business Mailing Address Fax Number:

304-720-8461

Provider First Line Business Practice Location Address:

1200 J D ANDERSON DR

Provider Second Line Business Practice Location Address:

MONONGALIA GENERAL HOSPITAL

Provider Business Practice Location Address City Name:

MORGANTOWN

Provider Business Practice Location Address State Name:

WV

Provider Business Practice Location Address Postal Code:

26505-3494

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

304-285-1200

Provider Business Practice Location Address Fax Number:

Provider Enumeration Date:

10/26/2006

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 367500000X , with the licence number:  68590 , registered in the state of WV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
• Taxonomy code: 367500000X , with the licence number: 17998 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

• Identifier: 001985246 . This is a "MSBCBS" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
• Identifier: 1070292 . This is a "BRICKSTREET" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
• Identifier: 270052997004 . This is a "TRICARE" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
• Identifier: DA0096 . This is a "RR MEDICARE" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
• Identifier: 27005299701 . This is a "BRICKSTREET GROUP" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
• Identifier: 3810006437 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".
• Identifier: 001706470 . This is a "MSBCBS GROUP" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
• Identifier: 0207026000 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".
• Identifier: 270052997 . This is a "TRI-CARE" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
• Identifier: P00453017 . This is a "RR MEDICARE" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".