Provider Demographics
NPI:1407184443
Name:GOOD FAITH ANESTHESIA SERVICES LLC
Entity Type:Organization
Organization Name:GOOD FAITH ANESTHESIA SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:H
Authorized Official - Last Name:BARTON
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:304-876-1453
Mailing Address - Street 1:PO BOX 159
Mailing Address - Street 2:
Mailing Address - City:BAKERTON
Mailing Address - State:WV
Mailing Address - Zip Code:25410-0159
Mailing Address - Country:US
Mailing Address - Phone:304-876-1453
Mailing Address - Fax:
Practice Address - Street 1:110 BAUGHMANS LN
Practice Address - Street 2:SUITE 201
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21702-4059
Practice Address - Country:US
Practice Address - Phone:301-679-7083
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-03
Last Update Date:2009-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty