Provider Demographics
NPI:1114007184
Name:BYUS, RONNIE D II (CRNA)
Entity Type:Individual
Prefix:
First Name:RONNIE
Middle Name:D
Last Name:BYUS
Suffix:II
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:46 THOROUGHBRED ROAD
Mailing Address - Street 2:
Mailing Address - City:SCOTT DEPOT
Mailing Address - State:WV
Mailing Address - Zip Code:25560
Mailing Address - Country:US
Mailing Address - Phone:304-757-0188
Mailing Address - Fax:
Practice Address - Street 1:1340 HAL GREER BLVD
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25701-3800
Practice Address - Country:US
Practice Address - Phone:205-322-1808
Practice Address - Fax:205-322-1851
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2020-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV57405367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV001788672OtherBCBS
WV3810004132Medicaid
OH2618493Medicaid
P00270294OtherPALMETTO GBA-RR MEDICARE
WV001788672OtherBCBS