Healthcare Provider Details

I. General information

NPI: 1336197359
Provider Name (Legal Business Name): JAMES F HEMESATH CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/04/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1118 FAIRINGTON DR
SIDNEY OH
45365-8913
US

IV. Provider business mailing address

P O BOX 2429
MURRELLS INLET SC
29576-2429
US

V. Phone/Fax

Practice location:
  • Phone: 937-492-3755
  • Fax:
Mailing address:
  • Phone: 843-651-2624
  • Fax: 843-357-4940

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN-131349
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: