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General NPI Number Information
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NPI Number | 1922497940
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Entity Type | Organization
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Legal Business Name | MALABAR ANESTHESIA SERVICES INC
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Dates
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Enumeration Date | 01/14/2015
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Last Update Date | 08/19/2015
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Provider Practice Location Address
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Address Line | 335 GLESSNER AVE
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City | MANSFIELD
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State | OH
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Zip | 44903-2269
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Country | US
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Telephone | 419-775-7877
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 182255
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City | COLUMBUS
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State | OH
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Zip | 43218-2255
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Country | US
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Telephone | 419-775-7877
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JOHN R JOHNSON
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Credential | CRNA
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Telephone | 419-775-7877
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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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