Basic Information
| Provider Information | |||||||||
| NPI: | 1588614234 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BEAR CREEK ANESTHESIA, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 216 MARENGO ST | ||||||||
| Address2: | C | ||||||||
| City: | FLORENCE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 356306012 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2567649697 | ||||||||
| FaxNumber: | 2567649699 | ||||||||
| Practice Location | |||||||||
| Address1: | 15155 HIGHWAY 43 | ||||||||
| Address2: | |||||||||
| City: | RUSSELLVILLE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 356531975 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2563328679 | ||||||||
| FaxNumber: | 2563328674 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/12/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | NUNNELLY | ||||||||
| AuthorizedOfficialFirstName: | BILL | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 2567649697 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology |
No ID Information.