=====================================================
General NPI Number Information
=====================================================
NPI Number | 1477965150
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MASK ANESTHESIA CONSULTANTS INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/29/2014
-----------------------------------------------------
Last Update Date | 05/17/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 275 TAYLOR STATION RD
-----------------------------------------------------
City | COLUMBUS
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43213-1445
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 614-751-4466
-----------------------------------------------------
Fax | 614-751-4474
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 713960
-----------------------------------------------------
City | CINCINNATI
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45271-3960
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 614-751-4466
-----------------------------------------------------
Fax | 614-751-4474
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. MARK W STANLEY
-----------------------------------------------------
Credential | D.O.
-----------------------------------------------------
Telephone | 614-751-4466
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207L00000X
-----------------------------------------------------
Taxonomy Name | Anesthesiology Physician
-----------------------------------------------------
License Number | 201412900247
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------