Healthcare Provider Details

I. General information

NPI: 1811167877
Provider Name (Legal Business Name): PREMIER ANESTHESIA CONSULTANTS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/06/2008
Last Update Date: 06/21/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5950 INNOVATION DRIVE
FRANKLIN OH
45005-2584
US

IV. Provider business mailing address

PO BOX 643863
CINCINNATI OH
45264-3863
US

V. Phone/Fax

Practice location:
  • Phone: 937-297-6072
  • Fax: 513-420-5747
Mailing address:
  • Phone: 937-297-6072
  • Fax: 513-420-5747

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: DR. THOMAS R. WARE
Title or Position: PRESIDENT
Credential: MD
Phone: 937-297-6072