=====================================================
General NPI Number Information
=====================================================
NPI Number | 1376636571
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BLUEFIELD ANESTHESIA ASSOCIATES INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/02/2006
-----------------------------------------------------
Last Update Date | 08/16/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 324 NORTH ST SUITE 2
-----------------------------------------------------
City | BLUEFIELD
-----------------------------------------------------
State | WV
-----------------------------------------------------
Zip | 24701-4038
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 304-327-3408
-----------------------------------------------------
Fax | 304-324-7967
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 324 NORTH ST SUITE 2
-----------------------------------------------------
City | BLUEFIELD
-----------------------------------------------------
State | WV
-----------------------------------------------------
Zip | 24701-4038
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 304-327-3408
-----------------------------------------------------
Fax | 304-324-7967
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | THOMAS MATHEW
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 304-327-3408
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207L00000X
-----------------------------------------------------
Taxonomy Name | Anesthesiology Physician
-----------------------------------------------------
License Number | 00329
-----------------------------------------------------
License Number State | WV
-----------------------------------------------------