Healthcare Provider Details

I. General information

NPI: 1437999018
Provider Name (Legal Business Name): ERIC MATTHEW BOYER CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/30/2024
Last Update Date: 06/18/2024
Certification Date: 06/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

272 HOSPITAL RD
CHILLICOTHEE OH
45601-9031
US

IV. Provider business mailing address

6994 LAKE RD NE
PLEASANTVILLE OH
43148-9762
US

V. Phone/Fax

Practice location:
  • Phone: 740-779-7540
  • Fax:
Mailing address:
  • Phone: 740-438-1434
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number0021037
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: