Healthcare Provider Details

I. General information

NPI: 1932397544
Provider Name (Legal Business Name): CHILDREN'S ANESTHESIA GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2007
Last Update Date: 06/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 CHILDREN'S PLZ
DAYTON OH
45404
US

IV. Provider business mailing address

1 CHILDREN'S PLZ
DAYTON OH
45404-1815
US

V. Phone/Fax

Practice location:
  • Phone: 937-641-3350
  • Fax: 937-641-6145
Mailing address:
  • Phone: 937-641-3350
  • Fax: 937-641-6145

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number StateOH
# 4
Primary TaxonomyY
Taxonomy Code207LP3000X
TaxonomyPediatric Anesthesiology Physician
License Number
License Number StateOH

VIII. Authorized Official

Name: MR. CHRIS BERGMAN
Title or Position: C.F.O.
Credential: CFO
Phone: 937-641-3338