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General NPI Number Information
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NPI Number | 1417951948
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Entity Type | Organization
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Legal Business Name | ANESTHESIA GROUP PRACTICE, INC
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Dates
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Enumeration Date | 06/13/2005
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Last Update Date | 10/16/2025
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Provider Practice Location Address
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Address Line | 10500 MONTGOMERY RD
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City | MONTGOMERY
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State | OH
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Zip | 45242-4402
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Country | US
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Telephone | 513-817-1150
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Fax | 513-351-0316
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Provider Business Mailing Address
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Address Line | PO BOX 632572
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City | CINCINNATI
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State | OH
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Zip | 45263-2572
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Country | US
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Telephone | 859-341-2666
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Fax | 513-351-0316
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Authorized Official
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Title or Position | CEO
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Name | MARK GROSSMAN
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Credential |
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Telephone | 513-817-1150
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207LC0200X
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Taxonomy Name | Critical Care Medicine (Anesthesiology) Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number |
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License Number State |
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