Healthcare Provider Details

I. General information

NPI: 1588836597
Provider Name (Legal Business Name): SPRINGFIELD REGIONAL ANESTHESIA, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/31/2008
Last Update Date: 03/31/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1343 N FOUNTAIN BLVD
SPRINGFIELD OH
45504-1422
US

IV. Provider business mailing address

L 3159
COLUMBUS OH
43260-1422
US

V. Phone/Fax

Practice location:
  • Phone: 937-298-5333
  • Fax:
Mailing address:
  • Phone: 937-298-5333
  • 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: GAIL MARKOFF
Title or Position: ADMIN
Credential: RN
Phone: 937-298-5333