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General NPI Number Information
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NPI Number | 1912040171
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Entity Type | Organization
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Legal Business Name | LUPI ANESTHESIA LLC
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Dates
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Enumeration Date | 02/15/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 8124 STOCKBRIDGE RD
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City | MENTOR
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State | OH
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Zip | 44060-7633
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Country | US
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Telephone | 440-479-8894
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Fax | 216-928-0141
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Provider Business Mailing Address
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Address Line | 8124 STOCKBRIDGE RD
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City | MENTOR
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State | OH
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Zip | 44060-7633
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Country | US
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Telephone | 440-479-8894
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Fax | 216-928-0141
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. ROCKY JAMES LUPI
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Credential | AA
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Telephone | 440-479-8894
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 367H00000X
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Taxonomy Name | Anesthesiologist Assistant
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License Number | 67.000103
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License Number State | OH
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