Healthcare Provider Details

I. General information

NPI: 1396715363
Provider Name (Legal Business Name): TRI-COUNTY ANESTHESIA INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/24/2006
Last Update Date: 02/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

981 WOOSTER RD
MILLERSBURG OH
44654
US

IV. Provider business mailing address

PO BOX 20451
COLUMBUS OH
43220
US

V. Phone/Fax

Practice location:
  • Phone: 614-451-7346
  • Fax: 614-451-5846
Mailing address:
  • Phone: 614-451-7346
  • Fax: 614-451-5846

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number35054628K
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number35049311A
License Number StateOH

VIII. Authorized Official

Name: MR. NATHANIEL NOBLE
Title or Position: AGENT
Credential:
Phone: 614-451-7346