Individual
MICHAEL B. STOUT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
100 JACKSON PIKE, GALLIPOLIS, OH 45631-1560
(740) 446-5227
(740) 441-8058
Mailing address
90 JACKSON PIKE, GALLIPOLIS, OH 45631-1560
(740) 446-5227
(740) 441-8058
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
159038
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000006844
ANTHEM BCBS
—
01
—
000000204808
OH MEDICAID UNISON
OH
01
—
001714074
MOUNTAIN STATE BCBS
—
05
—
0067558000
—
WV
01
—
0867245
MOLINA MEDICAID #
OH
05
—
0867245
—
OH
01
—
430028926
RR MEDICARE
OH
Enumeration date
07/19/2006
Last updated
12/29/2020
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