Healthcare Provider Details

I. General information

NPI: 1174581185
Provider Name (Legal Business Name): OSU HEALTH SYSTEM ANESTHESIA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/02/2006
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

410 W 10TH AVE N429 DOAN HALL
COLUMBUS OH
43210-1240
US

IV. Provider business mailing address

700 ACKERMAN RD STE 385
COLUMBUS OH
43202-1524
US

V. Phone/Fax

Practice location:
  • Phone: 614-293-4705
  • Fax: 614-293-8153
Mailing address:
  • Phone: 614-685-4313
  • Fax: 614-293-3606

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State

VIII. Authorized Official

Name: ANNE SMITH
Title or Position: ADMINISTRATIVE DIRECTOR
Credential:
Phone: 614-293-7444