Healthcare Provider Details

I. General information

NPI: 1326325929
Provider Name (Legal Business Name): ANESTHESIA STAFFING CONSULTANTS OF OHIO, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/10/2011
Last Update Date: 11/10/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

145 BAKER ST
MARION OH
43302-4111
US

IV. Provider business mailing address

30200 TELEGRAPH RD SUITE 220
BINGHAM FARMS MI
48025-4502
US

V. Phone/Fax

Practice location:
  • Phone: 248-258-2058
  • Fax: 248-927-5058
Mailing address:
  • Phone: 248-258-5058
  • Fax: 248-927-5058

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number State

VIII. Authorized Official

Name: PAUL SANTORO
Title or Position: CHIEF EXECUTIVE OFFICER
Credential: CRNA
Phone: 248-258-5058