Healthcare Provider Details

I. General information

NPI: 1609852144
Provider Name (Legal Business Name): FULTON ANESTHESIA ASSOCIATES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/16/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 DITTO ST
ARCHBOLD OH
43502
US

IV. Provider business mailing address

PO BOX 427
ARCHBOLD OH
43502
US

V. Phone/Fax

Practice location:
  • Phone: 419-445-1451
  • Fax: 419-445-0900
Mailing address:
  • Phone: 419-445-1451
  • Fax: 419-445-0900

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State

VIII. Authorized Official

Name: LARRY G SCHAEFER
Title or Position: VICE PRESIDENT FULTON ANESTHESIA
Credential: CRNA
Phone: 419-445-1451