1104110378 NPI number — ANESTHESIA ASSOCIATES PAIN, LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104110378 NPI number — ANESTHESIA ASSOCIATES PAIN, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ANESTHESIA ASSOCIATES PAIN, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1104110378
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/18/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1637
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PAINESVILLE
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44077
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
440-350-0832
Provider Business Mailing Address Fax Number:
440-354-7420

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7580 AUBURN ROAD
Provider Second Line Business Practice Location Address:
SUITE 102
Provider Business Practice Location Address City Name:
PAINESVILLE
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44077
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
440-350-3863
Provider Business Practice Location Address Fax Number:
440-350-3855
Provider Enumeration Date:
06/06/2011

Additional Information

Authorized Official

Authorized Official Last Name:
DONOHUE
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
F
Authorized Official Title or Position:
MANAGING PARNTER
Authorized Official Telephone Number:
440-350-0832

Provider Taxonomy Codes

  • Taxonomy code: 208VP0000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208VP0014X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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