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General NPI Number Information
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NPI Number | 1851656854
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Entity Type | Organization
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Legal Business Name | OPTIMUM ANESTHESIA
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Dates
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Enumeration Date | 07/06/2012
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Last Update Date | 02/19/2024
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Provider Practice Location Address
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Address Line | 1031 W WESTERN RESERVE RD
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City | POLAND
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State | OH
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Zip | 44514-3541
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Country | US
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Telephone | 330-965-0900
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Fax | 330-965-9250
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Provider Business Mailing Address
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Address Line | 4135 BOARDMAN CANFIELD RD SUITE 101
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City | CANFIELD
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State | OH
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Zip | 44406-9803
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Country | US
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Telephone | 330-286-5330
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Fax | 330-286-5396
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Authorized Official
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Title or Position | PRESIDENT
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Name | CHRISTOPHER T. THOMPSON
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Credential | CRNA
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Telephone | 330-519-7372
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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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