Healthcare Provider Details

I. General information

NPI: 1144248907
Provider Name (Legal Business Name): MID-ATLANTIC ANESTHESIA CONSULTANTS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/18/2006
Last Update Date: 05/14/2024
Certification Date: 05/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 HOSPITAL DR
HURRICANE WV
25526-9202
US

IV. Provider business mailing address

PO BOX 3466
CHARLESTON WV
25334-3466
US

V. Phone/Fax

Practice location:
  • Phone: 304-720-8816
  • Fax: 904-494-6467
Mailing address:
  • Phone: 304-720-8816
  • Fax: 904-494-6467

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number State

VIII. Authorized Official

Name: KENNETH F. MCNEIL
Title or Position: MANAGING MEMBER
Credential: M.D.
Phone: 304-720-8816