Healthcare Provider Details

I. General information

NPI: 1790733566
Provider Name (Legal Business Name): EASTSIDE ANESTHESIA GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2006
Last Update Date: 07/29/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8251 MAYFIELD RD STE 23
CHESTERLAND OH
44026-2567
US

IV. Provider business mailing address

8251 MAYFIELD RD STE 23
CHESTERLAND OH
44026-2567
US

V. Phone/Fax

Practice location:
  • Phone: 440-729-8221
  • Fax: 440-729-7896
Mailing address:
  • Phone: 440-729-8221
  • Fax: 440-729-7896

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. G. GARTH GRANT
Title or Position: PRESIDENT
Credential: CRNA
Phone: 440-729-8221