Provider Demographics
NPI:1396775284
Name:WEST RIVER ANESTHESIOLOGY CONSULTANTS PC
Entity type:Organization
Organization Name:WEST RIVER ANESTHESIOLOGY CONSULTANTS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JANET
Authorized Official - Middle Name:L
Authorized Official - Last Name:BLUMENTHAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-343-1333
Mailing Address - Street 1:PO BOX 2760
Mailing Address - Street 2:
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57709-2760
Mailing Address - Country:US
Mailing Address - Phone:605-343-1333
Mailing Address - Fax:605-343-6017
Practice Address - Street 1:353 FAIRMONT BLVD
Practice Address - Street 2:
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57701-7375
Practice Address - Country:US
Practice Address - Phone:605-343-1333
Practice Address - Fax:605-343-6017
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-04
Last Update Date:2007-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SDS2398Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER
SDS2398Medicare PIN