1518948264 NPI number — GREENWOOD ANESTHESIA & PAIN MGMT, PLLC

Table of Contents

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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