Healthcare Provider Details

I. General information

NPI: 1427059641
Provider Name (Legal Business Name): SUSAN WHITE ANESTHESIA, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2005
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29017 CEDAR RD
LYNDHURST OH
44124-4073
US

IV. Provider business mailing address

PO BOX 567
CHAGRIN FALLS OH
44022-0567
US

V. Phone/Fax

Practice location:
  • Phone: 440-460-8000
  • Fax: 440-460-1759
Mailing address:
  • Phone: 216-464-5160
  • Fax: 216-464-5982

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number StateOH

VIII. Authorized Official

Name: DR. SUSAN B WHITE
Title or Position: PRESIDENT
Credential: D.O.
Phone: 440-460-8000