Individual
CLIFFORD E. QUEEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
100 JACKSON PIKE, GALLIPOLIS, OH 45631-1560
(740) 446-5238
(740) 441-8058
Mailing address
90 JACKSON PIKE, GALLIPOLIS, OH 45631-1560
(740) 441-1949
(740) 446-5982
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
155948
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000006912
ANTHEM BCBS
—
01
—
001714073
MOUNTAIN STATE BCBS
—
05
—
0065208000
—
WV
01
—
0752118
MOLINA MEDICAID
OH
01
—
430028924
RR MEDICARE
—
Enumeration date
07/15/2006
Last updated
11/23/2020
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