Healthcare Provider Details

I. General information

NPI: 1427165570
Provider Name (Legal Business Name): MERCY ANESTHESIOLOGISTS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2006
Last Update Date: 02/15/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 W MAIN ST
SPRINGFIELD OH
45502-1312
US

IV. Provider business mailing address

2790 KILKENNY DR
SPRINGFIELD OH
45503-1181
US

V. Phone/Fax

Practice location:
  • Phone: 937-521-3900
  • Fax:
Mailing address:
  • Phone: 937-399-7164
  • Fax: 937-717-5370

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: THALES PAVLATOS
Title or Position: MANAGING DIRECTOR
Credential:
Phone: 937-399-7164