Healthcare Provider Details

I. General information

NPI: 1578836565
Provider Name (Legal Business Name): RIVER FRONT ANESTHESIA INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/22/2012
Last Update Date: 11/02/2021
Certification Date: 11/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

608 WASHINGTON BLVD
BELPRE OH
45714-2465
US

IV. Provider business mailing address

601 AVERY ST STE 501
PARKERSBURG WV
26101-5192
US

V. Phone/Fax

Practice location:
  • Phone: 304-422-3904
  • Fax: 304-422-3924
Mailing address:
  • Phone: 304-588-8683
  • Fax: 304-422-3924

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: JEFFREY R MATHENY
Title or Position: TREASURER
Credential:
Phone: 304-422-3904