Organization
EASTERN PANHANDLE ANESTHESIA ASSOCIATES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JACK F. SHAMBLIN III MD (PRESIDENT)
(304) 264-8933
Entity
Organization
Contact information
Practice address
2500 HOSPITAL ROAD, MARTINSBURG, WV 25401
(304) 264-8933
(304) 264-8846
Mailing address
109 MOUNT WOOD RD, WHEELING, WV 26003
(304) 233-2455
(304) 233-6073
Taxonomy
Speciality
Code
Description
License number
State
207LP2900X
Pain Medicine (Anesthesiology) Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0203593000
—
WV
01
—
CI6384
RAILROAD MEDICARE
WV
Enumeration date
03/24/2006
Last updated
01/14/2010
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