Healthcare Provider Details

I. General information

NPI: 1518614122
Provider Name (Legal Business Name): SOUTHWEST OHIO ANESTHETISTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/03/2022
Last Update Date: 08/23/2022
Certification Date: 08/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5700 GATEWAY STE 100
MASON OH
45040-1890
US

IV. Provider business mailing address

PO BOX 7096
STOCKTON CA
95267-0096
US

V. Phone/Fax

Practice location:
  • Phone: 513-229-7800
  • Fax: 513-229-7888
Mailing address:
  • Phone: 877-866-9877
  • Fax: 209-956-7733

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State

VIII. Authorized Official

Name: TRICIA K CROAKE
Title or Position: OWNER
Credential: MD
Phone: 513-608-8562