Healthcare Provider Details

I. General information

NPI: 1215118658
Provider Name (Legal Business Name): MAHONING ANESTHESIA CONSULTANTS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/14/2007
Last Update Date: 12/20/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7067 TIFFANY BLVD SUITE 230
YOUNGSTOWN OH
44514-1993
US

IV. Provider business mailing address

PO BOX 33
LOWELLVILLE OH
44436-0033
US

V. Phone/Fax

Practice location:
  • Phone: 330-758-2748
  • Fax: 330-758-3282
Mailing address:
  • Phone: 330-758-2748
  • Fax: 330-758-3282

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number34-006401
License Number StateOH

VIII. Authorized Official

Name: MRS. JENNIFER ERNST
Title or Position: PRACTICE MANAGER
Credential:
Phone: 330-758-2748