Healthcare Provider Details

I. General information

NPI: 1053686071
Provider Name (Legal Business Name): AMSURG TOLEDO ANESTHESIA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/09/2012
Last Update Date: 01/12/2023
Certification Date: 01/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4841 MONROE ST SUITE 111
TOLEDO OH
43623-4385
US

IV. Provider business mailing address

1A BURTON HILLS BLVD ATTN: PROVIDER ENROLLENT
NASHVILLE TN
37215-6187
US

V. Phone/Fax

Practice location:
  • Phone: 419-474-3949
  • Fax:
Mailing address:
  • Phone: 615-240-3809
  • Fax: 615-234-1809

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number State

VIII. Authorized Official

Name: JEAN KOCHENDORFER
Title or Position: SR DIRECTOR OF RCM TRANSFORMATION
Credential:
Phone: 615-263-4012