Provider Demographics
NPI:1366530685
Name:WHEELER, CARL A (CRNA)
Entity type:Individual
Prefix:
First Name:CARL
Middle Name:A
Last Name:WHEELER
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 711841
Mailing Address - Street 2:MID ATLANTIC ANESTHESIA CONSULTANTS
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43271-0001
Mailing Address - Country:US
Mailing Address - Phone:304-346-9400
Mailing Address - Fax:304-345-7320
Practice Address - Street 1:1200 J D ANDERSON DR
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26505-3494
Practice Address - Country:US
Practice Address - Phone:304-285-1200
Practice Address - Fax:304-345-7320
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2008-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV18008367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2460484Medicaid
WV000261804OtherMSBCBS
WV001706470OtherMSBCBS GROUP
WV2460484Medicaid
WV270052997004OtherTRICARE
OH0760467Medicaid
WV27005299700OtherWORKERS COMP GROUP
WV0207026000Medicaid
WV2605252000Medicaid
WVP00453014OtherRR MEDICARE
WV001706469OtherMSBCBS GROUP
WV1071985OtherWORKERS COMP
WVDA0096OtherRR MEDICARE
WVP00453014OtherRR MEDICARE
WVDA0096OtherRR MEDICARE