Healthcare Provider Details

I. General information

NPI: 1336482447
Provider Name (Legal Business Name): ANESTHESIA ASSOCIATES OF GARRETT COUNTY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2013
Last Update Date: 03/27/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

251 N 4TH ST
OAKLAND MD
21550-1375
US

IV. Provider business mailing address

3951 PALISADES DR
WEIRTON WV
26062-4326
US

V. Phone/Fax

Practice location:
  • Phone: 412-937-5848
  • Fax: 412-937-5708
Mailing address:
  • Phone: 412-937-5848
  • Fax: 412-937-5708

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number State

VIII. Authorized Official

Name: DOUGLAS L JACKSON
Title or Position: PRESIDENT
Credential: CRNA
Phone: 412-937-5848