Healthcare Provider Details

I. General information

NPI: 1447323233
Provider Name (Legal Business Name): JAMES BRADLEY BATES CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/17/2006
Last Update Date: 03/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9781 PINE COVE RD
WISE VA
24293-4435
US

IV. Provider business mailing address

THIRD STREET, NORTHEAST
NORTON VA
24273
US

V. Phone/Fax

Practice location:
  • Phone: 276-328-6843
  • Fax: 276-328-6843
Mailing address:
  • Phone: 276-679-9100
  • Fax: 276-679-1926

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number24164383
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: