Healthcare Provider Details

I. General information

NPI: 1770675936
Provider Name (Legal Business Name): ASSOCIATED ANESTHESIOLOGISTS OF SPRINGFIELD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2006
Last Update Date: 03/27/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1117 E HOME RD
SPRINGFIELD OH
45503-2725
US

IV. Provider business mailing address

PO BOX 3000
SPRINGFIELD OH
45501-3000
US

V. Phone/Fax

Practice location:
  • Phone: 937-342-1619
  • Fax: 937-390-7148
Mailing address:
  • Phone: 937-342-1619
  • Fax: 937-390-7148

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number35054847
License Number StateOH

VIII. Authorized Official

Name: KAMEL ABRAHAM
Title or Position: PRESIDENT
Credential: MD
Phone: 937-298-5333