Healthcare Provider Details

I. General information

NPI: 1285562140
Provider Name (Legal Business Name): PEDIATRIC ANESTHESIOLOGY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2026
Last Update Date: 05/11/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 E 6TH AVE
LANCASTER OH
43130-2595
US

IV. Provider business mailing address

4242 AIRPORT RD STE 100
CINCINNATI OH
45226-1615
US

V. Phone/Fax

Practice location:
  • Phone: 740-475-0700
  • Fax:
Mailing address:
  • Phone: 513-312-8652
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP3000X
TaxonomyPediatric Anesthesiology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. BERNARDUS TERREBLANCHE
Title or Position: CEO & CHIEF ANESTHESIOLOGIST
Credential: MD
Phone: 513-312-8652