Basic Information
| Provider Information | |||||||||
| NPI: | 1114973831 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FORD | ||||||||
| FirstName: | JANET | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | C.R.N.A. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 897 | ||||||||
| Address2: | |||||||||
| City: | MORGANTOWN | ||||||||
| State: | WV | ||||||||
| PostalCode: | 265070897 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3042937401 | ||||||||
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| Practice Location | |||||||||
| Address1: | 101 STADIUM DR | ||||||||
| Address2: | |||||||||
| City: | MORGANTOWN | ||||||||
| State: | WV | ||||||||
| PostalCode: | 265067911 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3045984000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/25/2006 | ||||||||
| LastUpdateDate: | 12/30/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | 021424 | WV | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
ID Information
| ID | Type | State | Issuer | Description | 27005299701 | 01 | WV | BRICKSTREET | OTHER | 001706470 | 01 | WV | MSBCBS GROUP | OTHER | P00229270 | 01 | WV | RR MEDICARE | OTHER | 0138176 | 05 | OH | MEDICAID | 486800700 | 01 | WV | FEDERAL EMPLOYEES | OTHER | 74011040 | 05 | KY | MEDICAID | 001720732 | 01 | WV | MOUNTAIN STATE BCBS | OTHER | 0067756000 | 05 | WV | MEDICAID | 1045406 | 01 | WV | BRICKSTREET INDIVIDUAL | OTHER | 148321800 | 05 | MD | MEDICAID | 270052997004 | 01 | WV | TRICARE | OTHER | 0207026000 | 05 | WV | MEDICAID | DA0096 | 01 | WV | RR MEDICARE | OTHER |