MEDICARE: UPPER VALLEY ANESTHESIA, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207L00000X	Anesthesiology Physician
2	367500000X	Certified Registered Nurse Anesthetist

General Provider Information

NPI Number	:	1124997432
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UPPER VALLEY ANESTHESIA, LLC

Provider Business Mailing Address
First Line	:	300 W MAIN ST
Second Line	:
City	:	SAINT CLAIRSVILLE
State	:	OH
Zip	:	43950-8801
Country	:	US
Telephone Number	:	740-449-2196
Fax Number	:

Provider Business Practice Location Address
First Line	:	300 W MAIN ST
Second Line	:
City	:	SAINT CLAIRSVILLE
State	:	OH
Zip	:	43950-8801
Country	:	US
Telephone Number	:	740-449-2196
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DANIEL SHATS
Credential	:	MD
Telephone Number	:	304-551-3839

Provider Enumeration Date	:	11/04/2025
Last Update Date	:	12/09/2025

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