Provider Demographics
NPI:1760592323
Name:SOUTHWEST ANESTHESIA, PC
Entity Type:Organization
Organization Name:SOUTHWEST ANESTHESIA, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:JULIUS
Authorized Official - Last Name:CICHOCKI
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:276-963-8504
Mailing Address - Street 1:2951 FRONT ST
Mailing Address - Street 2:STE 3050
Mailing Address - City:RICHLANDS
Mailing Address - State:VA
Mailing Address - Zip Code:24641-2055
Mailing Address - Country:US
Mailing Address - Phone:276-963-8504
Mailing Address - Fax:276-963-6642
Practice Address - Street 1:2951 FRONT ST
Practice Address - Street 2:STE 3050
Practice Address - City:RICHLANDS
Practice Address - State:VA
Practice Address - Zip Code:24641-2055
Practice Address - Country:US
Practice Address - Phone:276-963-8504
Practice Address - Fax:276-963-6642
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
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
VA258850OtherANTHEM BCBS
VACH8135OtherRAILROAD MEDICARE
WV0202566-000OtherMEDICAID WV
WV0202566-000OtherMEDICAID WV