Provider Demographics
NPI:1588614234
Name:BEAR CREEK ANESTHESIA, INC.
Entity type:Organization
Organization Name:BEAR CREEK ANESTHESIA, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BILL
Authorized Official - Middle Name:
Authorized Official - Last Name:NUNNELLY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:256-764-9697
Mailing Address - Street 1:216 MARENGO ST
Mailing Address - Street 2:C
Mailing Address - City:FLORENCE
Mailing Address - State:AL
Mailing Address - Zip Code:35630-6012
Mailing Address - Country:US
Mailing Address - Phone:256-764-9697
Mailing Address - Fax:256-764-9699
Practice Address - Street 1:15155 HIGHWAY 43
Practice Address - Street 2:
Practice Address - City:RUSSELLVILLE
Practice Address - State:AL
Practice Address - Zip Code:35653-1975
Practice Address - Country:US
Practice Address - Phone:256-332-8679
Practice Address - Fax:256-332-8674
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALJ601Medicare ID - Type UnspecifiedMEDICARE GROUP
ALJ602Medicare ID - Type UnspecifiedMEDICARE GROUP