Provider Demographics
NPI:1336247949
Name:CARDIAC ANESTHESIA PLUS, INC.
Entity Type:Organization
Organization Name:CARDIAC ANESTHESIA PLUS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:J
Authorized Official - Last Name:SHY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-399-0137
Mailing Address - Street 1:PO BOX 8225
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25705-0225
Mailing Address - Country:US
Mailing Address - Phone:304-399-0137
Mailing Address - Fax:304-399-0138
Practice Address - Street 1:2900 1ST AVE
Practice Address - Street 2:#6019
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25702-1241
Practice Address - Country:US
Practice Address - Phone:304-399-0137
Practice Address - Fax:304-399-0138
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DB7669OtherRAILROAD MEDICARE
204052OtherBLACK LUNG
OH2473130Medicaid
WV0209236000Medicaid
DB7669OtherRAILROAD MEDICARE