Provider Demographics
NPI:1376636571
Name:BLUEFIELD ANESTHESIA ASSOCIATES INC
Entity Type:Organization
Organization Name:BLUEFIELD ANESTHESIA ASSOCIATES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:MATHEW
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:304-327-3408
Mailing Address - Street 1:324 NORTH ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:BLUEFIELD
Mailing Address - State:WV
Mailing Address - Zip Code:24701-4038
Mailing Address - Country:US
Mailing Address - Phone:304-327-3408
Mailing Address - Fax:304-324-7967
Practice Address - Street 1:324 NORTH ST
Practice Address - Street 2:SUITE 2
Practice Address - City:BLUEFIELD
Practice Address - State:WV
Practice Address - Zip Code:24701-4038
Practice Address - Country:US
Practice Address - Phone:304-327-3408
Practice Address - Fax:304-324-7967
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2007-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV00329207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810005826Medicaid
WV9157411Medicare PIN
WVCE5126Medicare PIN