Healthcare Provider Details

I. General information

NPI: 1043633993
Provider Name (Legal Business Name): ANESTHESIOLOGISTS D.O. INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/29/2014
Last Update Date: 01/29/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1011 BOARDMAN CANFIELD RD
BOARDMAN OH
44512-4226
US

IV. Provider business mailing address

1011 BOARDMAN CANFIELD RD
BOARDMAN OH
44512-4226
US

V. Phone/Fax

Practice location:
  • Phone: 330-629-2888
  • Fax: 330-629-8940
Mailing address:
  • Phone: 330-629-2888
  • Fax: 330-629-8940

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SA2200X
TaxonomyAdult Health Clinical Nurse Specialist
License Number09915-NS
License Number StateOH

VIII. Authorized Official

Name: CARISA L SECHRIST
Title or Position: CREDENTIALING SPECIALIST
Credential: AAS
Phone: 330-629-2888