Healthcare Provider Details

I. General information

NPI: 1588898548
Provider Name (Legal Business Name): OHIO SURGICAL ANESTHESIA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/06/2009
Last Update Date: 10/31/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5319 HOAG DR ROOM 1
SHEFFIELD VILLAGE OH
44035-1494
US

IV. Provider business mailing address

PO BOX 310407
DES MOINES IA
50331-0407
US

V. Phone/Fax

Practice location:
  • Phone: 855-600-5161
  • Fax: 706-650-1034
Mailing address:
  • Phone: 800-394-4445
  • Fax: 706-650-1034

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. ANDREW RIBAUDO
Title or Position: PRESIDENT
Credential:
Phone: 404-217-2659