Healthcare Provider Details

I. General information

NPI: 1508813528
Provider Name (Legal Business Name): BEL-PARK ANESTHESIA ASSOCIATES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2006
Last Update Date: 06/22/2020
Certification Date: 06/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1044 BELMONT AVE
YOUNGSTOWN OH
44504-1006
US

IV. Provider business mailing address

PO BOX 460
CANFIELD OH
44406-0460
US

V. Phone/Fax

Practice location:
  • Phone: 330-286-5330
  • Fax: 330-286-5396
Mailing address:
  • Phone: 330-286-5330
  • Fax: 330-286-5396

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number State

VIII. Authorized Official

Name: MR. THOMAS A. DEASCENTIS
Title or Position: EXECUTIVE DIRECTOR
Credential: MBA
Phone: 330-286-5330