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General NPI Number Information
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NPI Number | 1639348113
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Entity Type | Organization
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Legal Business Name | OHIO ANESTHESIA GROUP, INC
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Dates
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Enumeration Date | 02/28/2008
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Last Update Date | 03/15/2019
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Provider Practice Location Address
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Address Line | 1320 MERCY DR NW
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City | CANTON
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State | OH
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Zip | 44708-2614
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Country | US
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Telephone | 330-656-5215
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Fax |
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Provider Business Mailing Address
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Address Line | 4665 DOUGLAS CIR NW STE 100
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City | CANTON
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State | OH
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Zip | 44718-3673
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Country | US
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Telephone | 330-499-5700
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Fax |
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Authorized Official
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Title or Position | AUTHORISED REPRESENTATIVE
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Name | MR. ALFRED J MARTELLO
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Credential |
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Telephone | 330-656-5215
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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 #2
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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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