=====================================================
General NPI Number Information
=====================================================
NPI Number | 1821042342
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FALLS ANESTHESIA GROUP INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/20/2006
-----------------------------------------------------
Last Update Date | 04/05/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1900 23RD ST
-----------------------------------------------------
City | CUYAHOGA FALLS
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44223-1404
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 330-971-7000
-----------------------------------------------------
Fax | 330-296-6535
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2106 ALBERTSON PKWY
-----------------------------------------------------
City | CUYAHOGA FALLS
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44223-2502
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 330-971-7000
-----------------------------------------------------
Fax | 330-296-6535
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. MARK S SMILEK
-----------------------------------------------------
Credential | DO
-----------------------------------------------------
Telephone | 330-971-0401
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207L00000X
-----------------------------------------------------
Taxonomy Name | Anesthesiology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------