Healthcare Provider Details

I. General information

NPI: 1114007184
Provider Name (Legal Business Name): RONNIE D BYUS II CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/16/2006
Last Update Date: 12/30/2020
Certification Date: 12/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1340 HAL GREER BLVD
HUNTINGTON WV
25701-3800
US

IV. Provider business mailing address

46 THOROUGHBRED ROAD
SCOTT DEPOT WV
25560
US

V. Phone/Fax

Practice location:
  • Phone: 205-322-1808
  • Fax: 205-322-1851
Mailing address:
  • Phone: 304-757-0188
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number57405
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: