1225079544 NPI number — MICHELLE L STOTTS CRNA

Table of content: MICHELLE L STOTTS CRNA (NPI 1225079544)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225079544 NPI number — MICHELLE L STOTTS CRNA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
STOTTS
Provider First Name:
MICHELLE
Provider Middle Name:
L
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CRNA
Provider Gender Code:
F

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:
1225079544
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/06/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
200 HOSPITAL DR
Provider Second Line Business Mailing Address:
MID ATLANTIC ANESTHESIA CONSULTANTS
Provider Business Mailing Address City Name:
SPENCER
Provider Business Mailing Address State Name:
WV
Provider Business Mailing Address Postal Code:
25276-1050
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:
720 PINNELL ST
Provider Second Line Business Practice Location Address:
JACKSON GENERAL HOSPITAL
Provider Business Practice Location Address City Name:
RIPLEY
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
25271
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-373-1544
Provider Business Practice Location Address Fax Number:
304-373-0044
Provider Enumeration Date:
06/09/2006

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: 367500000X , with the licence number:  52711 , 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: 0207026000 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".
  • Identifier: DA0096 . This is a "RR MEDICARE" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: 001721843 . This is a "BCBS" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: 001706470 . This is a "MSBCBS" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: 2605278000 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00158674 . This is a "RR MEDICARE" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: 233080009300 . This is a "OHIO WORKERS' COMP" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 270052997002 . This is a "TRICARE" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: 2435118 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2460484 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 27005299700 . This is a "BRICKSTREET" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".




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