Smallridge, Justin David

Smallridge, Justin David is an individual health care provider with primary practice located at 327 Medical Park Dr , Bridgeport WV 26330-9006. He recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Nurse Anesthetist, Certified Registered, which is considered as his primary health care specialty. Smallridge, Justin David can be contacted via phone (681) 342-1000.

Contact Information

Primary practice address
327 Medical Park Dr Bridgeport WV 26330-9006
Phone: (681) 342-1000
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Nurse Anesthetist, Certified Registered 367500000X 58541 West Virginia

Profile Details

NPI number 1417904848
LBN Legal business name Smallridge, Justin David
Credentials Certified Registered Nurse Anesthetist (CRNA)
Entity Individual
Sole proprietor 1 No
Enumeration date May 30th, 2006
Last updated Mar 17th, 2018 - about 7 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1417904848 NPPES
West Virginia Other 0207026000 MEDICAID GROUP
West Virginia MEDICAID 3810005046 MEDICAID GROUP
West Virginia Other P00974070 MEDICAID GROUP
West Virginia Other 9333201 MEDICAID GROUP
West Virginia Other 1417904848 MEDICAID GROUP

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