Healthcare Provider Details

I. General information

NPI: 1174597710
Provider Name (Legal Business Name): JAMES C. PADGETT CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/13/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5901 MONCLOVA RD
MAUMEE OH
43537-1855
US

IV. Provider business mailing address

5901 MONCLOVA RD
MAUMEE OH
43537-1855
US

V. Phone/Fax

Practice location:
  • Phone: 419-897-8370
  • Fax:
Mailing address:
  • Phone: 419-897-8370
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberCOA.03112-NA
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: