Healthcare Provider Details

I. General information

NPI: 1639348113
Provider Name (Legal Business Name): OHIO ANESTHESIA GROUP, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/28/2008
Last Update Date: 03/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1320 MERCY DR NW
CANTON OH
44708-2614
US

IV. Provider business mailing address

4665 DOUGLAS CIR NW STE 100
CANTON OH
44718-3673
US

V. Phone/Fax

Practice location:
  • Phone: 330-656-5215
  • Fax:
Mailing address:
  • Phone: 330-499-5700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number State

VIII. Authorized Official

Name: MR. ALFRED J MARTELLO
Title or Position: AUTHORISED REPRESENTATIVE
Credential:
Phone: 330-656-5215