Organization
PRODIGY OFFICE ANESTHESIA, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BENJAMIN T. SMALL CRNA (ORGANIZER)
(304) 741-4957
Entity
Organization
Contact information
Practice address
1710 CUMBERLAND FALLS HWY, CORBIN, KY 40701-2727
(606) 528-6700
Mailing address
917 COUNTRY OAKS DR, RICHMOND, KY 40475-8492
(304) 741-4957
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
—
—
Other
Enumeration date
10/10/2023
Last updated
10/10/2023
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