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General NPI Number Information
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NPI Number | 1053532390
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Entity Type | Organization
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Legal Business Name | CLINTON ANESTHESIA ASSOCIATES INC.
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Dates
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Enumeration Date | 05/02/2007
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Last Update Date | 09/23/2008
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Provider Practice Location Address
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Address Line | 807 W MAIN ST
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City | WILMINGTON
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State | OH
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Zip | 45177-2128
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Country | US
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Telephone | 937-382-1864
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Fax | 937-382-8917
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Provider Business Mailing Address
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Address Line | 807 W MAIN ST P.O. BOX 868
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City | WILMINGTON
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State | OH
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Zip | 45177-2128
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Country | US
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Telephone | 937-382-1864
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Fax | 937-382-8917
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. CONNIE S. HORN
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Credential | M.D.
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Telephone | 937-382-1864
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 35 051308
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License Number State | OH
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