Provider Demographics
NPI:1700839008
Name:BEECHMONT ANESTHESIA
Entity Type:Organization
Organization Name:BEECHMONT ANESTHESIA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING CREDENTIALING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:RENEE
Authorized Official - Middle Name:
Authorized Official - Last Name:STROUP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-501-6863
Mailing Address - Street 1:PO BOX 70
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN TOP
Mailing Address - State:PA
Mailing Address - Zip Code:18707
Mailing Address - Country:US
Mailing Address - Phone:570-501-6860
Mailing Address - Fax:570-501-6869
Practice Address - Street 1:50 MOISEY DRIVE
Practice Address - Street 2:SUITE 204
Practice Address - City:HAZLETON
Practice Address - State:PA
Practice Address - Zip Code:18202
Practice Address - Country:US
Practice Address - Phone:570-501-6860
Practice Address - Fax:570-501-6869
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-18
Last Update Date:2008-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1013091350001Medicaid
PA1013091350001Medicaid