Healthcare Provider Details

I. General information

NPI: 1871144204
Provider Name (Legal Business Name): ERIC R AMBRUS CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2019
Last Update Date: 09/26/2019
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

150 BLUFF AVE
NORTH AUGUSTA SC
29841-3862
US

V. Phone/Fax

Practice location:
  • Phone: 330-489-1000
  • Fax:
Mailing address:
  • Phone: 800-394-4445
  • Fax: 706-396-3252

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number019959
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: