Healthcare Provider Details

I. General information

NPI: 1144380213
Provider Name (Legal Business Name): MVB ANESTHESIA PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2006
Last Update Date: 09/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 MEDICAL DR
GUYMON OK
73942-4438
US

IV. Provider business mailing address

634 NE 20TH ST
GUYMON OK
73942-3035
US

V. Phone/Fax

Practice location:
  • Phone: 580-338-3113
  • Fax: 580-338-4230
Mailing address:
  • Phone: 580-651-7468
  • Fax: 580-338-4230

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP3300X
TaxonomyPain Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MARIA LYNNE VANBEBBER
Title or Position: PRESIDENT
Credential: MSN, CRNA
Phone: 580-651-7468