Provider Demographics
NPI:1225071517
Name:MONTY, STEVEN J (CRNA)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:J
Last Name:MONTY
Suffix:
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:PO BOX 3466
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25334-3466
Mailing Address - Country:US
Mailing Address - Phone:304-720-8816
Mailing Address - Fax:904-494-6467
Practice Address - Street 1:1400 HOSPITAL DR
Practice Address - Street 2:CAMC TEAYS VALLEY HOSPITAL
Practice Address - City:HURRICANE
Practice Address - State:WV
Practice Address - Zip Code:25526-9202
Practice Address - Country:US
Practice Address - Phone:304-720-8816
Practice Address - Fax:904-494-6467
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2020-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC243259367500000X
WV32300367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV205542387OtherAAP TRI CARE NUMBER
WV27005299700OtherAAP - BRICKSTREET
MD406127600OtherMARYLAND MEDICAID
WV001721147OtherBCBS AAP NUMBER
WV55074547000OtherWORKERS COMP
WVDA0096OtherRR MEDICARE
WV001721147OtherMAAC - BCBS
WV001907661OtherMSBCBS
WV20554238700OtherWORKERS COMP
WV02070269000Medicaid
WV001706470OtherMSBCBS GROUP
OH2268942Medicaid
WVP00001170OtherRR MEDICARE
WV001721147OtherMSBCBS
WV1059945OtherWORKERS COMP INDIVIDUAL
WV3810006746Medicaid
WV0065156000Medicaid
MD406127600OtherMARYLAND MEDICAID
WV27005299700OtherAAP - BRICKSTREET
WV9364011Medicare PIN