Individual
JUSTIN DAVID SMALLRIDGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
230 HOSPITAL PLZ, WESTON, WV 26452-8558
(304) 269-8000
(304) 269-8090
Mailing address
230 HOSPITAL PLZ, WESTON, WV 26452-8558
(304) 269-8000
(304) 269-8090
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
APRN58541
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0207026000
MEDICAID GROUP
WV
01
—
1417904848
MT STATE BLUE CROSS & BLUE SHIELD
WV
05
—
3810005046
—
WV
01
—
9333201
MEDICARE GROUP
WV
01
—
P00974070
MEDICARE RAILROAD
WV
Enumeration date
05/30/2006
Last updated
03/11/2025
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