MEDICARE: SOUTHWEST ANESTHESIA, PC

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

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	CH8135	OTHER	VA	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	258850	OTHER	VA	ANTHEM BCBS
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1760592323
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTHWEST ANESTHESIA, PC

Provider Business Mailing Address
First Line	:	2951 FRONT ST
Second Line	:	STE 3050
City	:	RICHLANDS
State	:	VA
Zip	:	24641-2055
Country	:	US
Telephone Number	:	276-963-8504
Fax Number	:	276-963-6642

Provider Business Practice Location Address
First Line	:	2951 FRONT ST
Second Line	:	STE 3050
City	:	RICHLANDS
State	:	VA
Zip	:	24641-2055
Country	:	US
Telephone Number	:	276-963-8504
Fax Number	:	276-963-6642

Authorized Official
Title or Position	:	OWNER/OPERATOR
Name	:	MR. ANTHONY JULIUS CICHOCKI
Credential	:	CRNA
Telephone Number	:	276-963-8504

Provider Enumeration Date	:	08/30/2006
Last Update Date	:	08/22/2020

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Directions to “SOUTHWEST ANESTHESIA, PC ” Practice Location

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