Provider Demographics
NPI:1114973831
Name:FORD, JANET M (CRNA)
Entity Type:Individual
Prefix:
First Name:JANET
Middle Name:M
Last Name:FORD
Suffix:
Gender:F
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:PO BOX 897
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26507-0897
Mailing Address - Country:US
Mailing Address - Phone:304-293-7401
Mailing Address - Fax:
Practice Address - Street 1:101 STADIUM DR
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26506-7911
Practice Address - Country:US
Practice Address - Phone:304-598-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2008-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV021424367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV27005299701OtherBRICKSTREET
WV001706470OtherMSBCBS GROUP
WVP00229270OtherRR MEDICARE
OH0138176Medicaid
WV486800700OtherFEDERAL EMPLOYEES
KY74011040Medicaid
WV001720732OtherMOUNTAIN STATE BCBS
WV0067756000Medicaid
WV1045406OtherBRICKSTREET INDIVIDUAL
MD148321800Medicaid
WV270052997004OtherTRICARE
WV0207026000Medicaid
WVDA0096OtherRR MEDICARE
WV9333201Medicare PIN
WV27005299701OtherBRICKSTREET