Healthcare Provider Details

I. General information

NPI: 1295306140
Provider Name (Legal Business Name): JOSEPH AUSTIN RUNYAN CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/01/2021
Last Update Date: 03/11/2022
Certification Date: 03/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1003 BELLEFONTAINE AVE
LIMA OH
45804-2868
US

IV. Provider business mailing address

4 SURREY CT
PLAIN CITY OH
43064-2107
US

V. Phone/Fax

Practice location:
  • Phone: 419-228-3335
  • Fax:
Mailing address:
  • Phone: 614-937-8994
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number63568
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAPRN.CRNA.0020350
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: