Healthcare Provider Details

I. General information

NPI: 1598703951
Provider Name (Legal Business Name): MIDWEST PHYSICIAN ANESTHESIA SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2006
Last Update Date: 06/19/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5151 REED ROAD SUITE 225-C
COLUMBUS OH
43220-2595
US

IV. Provider business mailing address

5151 REED ROAD SUITE 225-C
COLUMBUS OH
43220-2595
US

V. Phone/Fax

Practice location:
  • Phone: 614-884-0641
  • Fax: 614-884-0776
Mailing address:
  • Phone: 614-884-0641
  • Fax: 614-884-0776

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MRS. EILEEN M KROTINE
Title or Position: PRACTICE MANAGER
Credential:
Phone: 614-457-2306