Healthcare Provider Details

I. General information

NPI: 1518948264
Provider Name (Legal Business Name): GREENWOOD ANESTHESIA & PAIN MGMT, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/09/2005
Last Update Date: 03/27/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 RIVER RD ANESTHESIA DEPARTMENT
GREENWOOD MS
38930-4030
US

IV. Provider business mailing address

29 CREAMERY LN
EASTON MD
21601-3137
US

V. Phone/Fax

Practice location:
  • Phone: 662-459-7000
  • Fax:
Mailing address:
  • Phone: 800-222-1335
  • Fax: 410-819-0712

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number16017
License Number StateMS

VIII. Authorized Official

Name: TODD BESSELIEVRE
Title or Position: PRESIDENT
Credential: M.D.
Phone: 800-222-1335