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General NPI Number Information
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NPI Number | 1821097361
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Entity Type | Organization
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Legal Business Name | WEST BROAD ANESTHESIA, INC.
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Dates
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Enumeration Date | 07/18/2005
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Last Update Date | 04/23/2025
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Provider Practice Location Address
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Address Line | 5100 W. BROAD STREET
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City | COLUMBUS
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State | OH
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Zip | 43228-1607
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Country | US
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Telephone | 614-354-4354
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Fax | 614-853-2699
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Provider Business Mailing Address
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Address Line | PO BOX 715184
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City | COLUMBUS
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State | OH
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Zip | 43271-5184
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Country | US
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Telephone | 614-354-4354
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Fax | 937-293-0960
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MATTHEW R BROWN
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Credential | D.O.
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Telephone | 614-354-4354
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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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 | 174400000X
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Taxonomy Name | Specialist
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License Number | 34005581B
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License Number State | OH
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