Healthcare Provider Details

I. General information

NPI: 1811997869
Provider Name (Legal Business Name): GENERAL ANESTHESIA SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2005
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3508 STAUNTON AVE SE
CHARLESTON WV
25304-1477
US

IV. Provider business mailing address

PO BOX 3444
CHARLESTON WV
25334-3444
US

V. Phone/Fax

Practice location:
  • Phone: 304-925-4086
  • Fax:
Mailing address:
  • Phone: 304-925-5486
  • Fax: 304-925-8075

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number StateWV

VIII. Authorized Official

Name: TIMOTHY NELSON
Title or Position: PRESIDENT
Credential: M.D.
Phone: 304-925-4086