Healthcare Provider Details

I. General information

NPI: 1962574160
Provider Name (Legal Business Name): EASTRIVER ANESTHESIA SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/14/2006
Last Update Date: 12/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 NAVARRE AVE
OREGON OH
43616-3207
US

IV. Provider business mailing address

2600 NAVARRE AVE
OREGON OH
43616-3207
US

V. Phone/Fax

Practice location:
  • Phone: 419-696-7701
  • Fax: 419-696-7866
Mailing address:
  • Phone: 419-696-7701
  • Fax: 419-696-7866

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: SUKHWINDER S GILL
Title or Position: PRESIDENT
Credential: MD
Phone: 419-696-7701