Healthcare Provider Details

I. General information

NPI: 1225079270
Provider Name (Legal Business Name): BUCKEYE ANESTHESIA SERVICES & CONSULTANTS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2006
Last Update Date: 01/04/2022
Certification Date: 01/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 MEDICAL DR SUITE A
LIMA OH
45804-4099
US

IV. Provider business mailing address

PO BOX 714813
COLUMBUS OH
43271-4813
US

V. Phone/Fax

Practice location:
  • Phone: 419-224-7586
  • Fax: 419-224-9769
Mailing address:
  • Phone: 937-293-0247
  • Fax: 937-293-0969

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier2460457
Identifier TypeMEDICAID
Identifier StateOH
Identifier Issuer
# 2
IdentifierDB0764
Identifier TypeOTHER
Identifier StateOH
Identifier IssuerRAILROAD MEDICARE
# 3
Identifier125460100
Identifier TypeOTHER
Identifier State
Identifier IssuerFEDERAL WORKERS COMP ACS
# 4
Identifier000000318057
Identifier TypeOTHER
Identifier StateOH
Identifier IssuerANTHEM

VIII. Authorized Official

Name: DR. MARK A WANGLER
Title or Position: PRESIDENT
Credential: MD
Phone: 419-224-7586