Healthcare Provider Details

I. General information

NPI: 1497709554
Provider Name (Legal Business Name): THOMAS J GIOMPALO CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2006
Last Update Date: 12/07/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 TWIN OAKS DR
HUNTINGTON WV
25701-9200
US

IV. Provider business mailing address

5 TWIN OAKS DR
HUNTINGTON WV
25701-9200
US

V. Phone/Fax

Practice location:
  • Phone: 304-523-3749
  • Fax: 304-697-1628
Mailing address:
  • Phone: 304-523-3749
  • Fax: 304-697-1628

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number22611
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: