Provider Demographics
NPI:1144380213
Name:MVB ANESTHESIA PLLC
Entity Type:Organization
Organization Name:MVB ANESTHESIA PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:LYNNE
Authorized Official - Last Name:VANBEBBER
Authorized Official - Suffix:
Authorized Official - Credentials:MSN, CRNA
Authorized Official - Phone:580-651-7468
Mailing Address - Street 1:634 NE 20TH ST
Mailing Address - Street 2:
Mailing Address - City:GUYMON
Mailing Address - State:OK
Mailing Address - Zip Code:73942-3035
Mailing Address - Country:US
Mailing Address - Phone:580-651-7468
Mailing Address - Fax:580-338-4230
Practice Address - Street 1:520 MEDICAL DR
Practice Address - Street 2:
Practice Address - City:GUYMON
Practice Address - State:OK
Practice Address - Zip Code:73942-4438
Practice Address - Country:US
Practice Address - Phone:580-338-3113
Practice Address - Fax:580-338-4230
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-11
Last Update Date:2008-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200100820AMedicaid
OK300522289Medicare PIN