Healthcare Provider Details

I. General information

NPI: 1518137934
Provider Name (Legal Business Name): MAKIT ANESTHESIA INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/03/2008
Last Update Date: 06/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 OAKWOOD RD
CANVAS WV
26662-0109
US

IV. Provider business mailing address

PO BOX 1012
PRINCETON WV
24740-1012
US

V. Phone/Fax

Practice location:
  • Phone: 304-872-9066
  • Fax: 304-872-9066
Mailing address:
  • Phone: 304-647-4570
  • Fax: 304-872-9066

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MRS. KRISTA L COPENHAVER-MACKOWIAK
Title or Position: VICE PRESIDENT CRNA
Credential: CRNA
Phone: 304-872-9066