Healthcare Provider Details

I. General information

NPI: 1679501902
Provider Name (Legal Business Name): EUGENE THOMPSON CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2006
Last Update Date: 11/03/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 SIXTH STREET SW OHIO HOSPITAL BASED PHYSICIANS CORP
CANTON OH
44710
US

IV. Provider business mailing address

2600 SIXTH STREET SW OHIO HOSPITAL BASED PHYSICIANS CORP
CANTON OH
44710
US

V. Phone/Fax

Practice location:
  • Phone: 330-363-7462
  • Fax: 330-363-7679
Mailing address:
  • Phone: 330-363-7462
  • Fax: 330-363-7679

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN192351
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: