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General NPI Number Information
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NPI Number | 1073814513
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Entity Type | Organization
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Legal Business Name | MOUNTAIN ANESTHESIA, LLC
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Dates
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Enumeration Date | 11/16/2010
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Last Update Date | 11/16/2010
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Provider Practice Location Address
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Address Line | 2830 DAVIS STURT ROAD
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City | LEWISBURG
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State | WV
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Zip | 24901
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Country | US
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Telephone | 304-731-2313
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Fax | 304-647-4570
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Provider Business Mailing Address
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Address Line | PO BOX 631
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City | LEWISBURG
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State | WV
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Zip | 24901-0631
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Country | US
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Telephone | 304-731-2313
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Fax | 304-647-4570
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Authorized Official
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Title or Position | OWNER
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Name | MR. BRADLEY PERSINGER
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Credential | CRNA
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Telephone | 304-542-3927
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 2245-8943
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License Number State | WV
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