Healthcare Provider Details

I. General information

NPI: 1417276429
Provider Name (Legal Business Name): NORTHSTAR ANESTHESIA OF OHIO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2010
Last Update Date: 05/25/2021
Certification Date: 05/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2615 E HIGH ST
SPRINGFIELD OH
45505-1412
US

IV. Provider business mailing address

PO BOX 227096
DALLAS TX
75222-7096
US

V. Phone/Fax

Practice location:
  • Phone: 214-687-0496
  • Fax:
Mailing address:
  • Phone: 239-610-0775
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. PHILIP W EICHENHOLZ
Title or Position: PRESIDENT CEO
Credential: MD
Phone: 888-861-3994