Healthcare Provider Details

I. General information

NPI: 1366631558
Provider Name (Legal Business Name): ANESTHESIA CARE ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2007
Last Update Date: 10/24/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 TWIN OAKS DRIVE
HUNTINGTON WV
25701
US

IV. Provider business mailing address

5 TWIN OAKS DRIVE
HUNTINGTON WV
25701
US

V. Phone/Fax

Practice location:
  • Phone: 304-523-3749
  • Fax:
Mailing address:
  • Phone: 304-523-3749
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number22611
License Number StateWV

VIII. Authorized Official

Name: MR. THOMAS J GIOMPALO
Title or Position: PROVIDER / OWNER
Credential: CRNA
Phone: 304-523-3749