Provider Demographics
NPI:1518948264
Name:GREENWOOD ANESTHESIA & PAIN MGMT, PLLC
Entity Type:Organization
Organization Name:GREENWOOD ANESTHESIA & PAIN MGMT, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TODD
Authorized Official - Middle Name:
Authorized Official - Last Name:BESSELIEVRE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:800-222-1335
Mailing Address - Street 1:29 CREAMERY LN
Mailing Address - Street 2:
Mailing Address - City:EASTON
Mailing Address - State:MD
Mailing Address - Zip Code:21601-3137
Mailing Address - Country:US
Mailing Address - Phone:800-222-1335
Mailing Address - Fax:410-819-0712
Practice Address - Street 1:1401 RIVER RD
Practice Address - Street 2:ANESTHESIA DEPARTMENT
Practice Address - City:GREENWOOD
Practice Address - State:MS
Practice Address - Zip Code:38930-4030
Practice Address - Country:US
Practice Address - Phone:662-459-7000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-09
Last Update Date:2012-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS16017207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS08074314Medicaid
MS08074314Medicaid