1154571586 NPI number — OFFICE BASED ANESTHESIA ASSOCIATES

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 1154571586 NPI number — OFFICE BASED ANESTHESIA ASSOCIATES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
OFFICE BASED ANESTHESIA ASSOCIATES
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:
OBAA, LLC
Provider Other Organization Name Type Code:
5
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:
1154571586
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/23/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2604 MARLO WAY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAKESIDE PARK
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
41017-2150
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
859-331-8326
Provider Business Mailing Address Fax Number:
859-331-8326

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10475 READING RD
Provider Second Line Business Practice Location Address:
SUITE 115
Provider Business Practice Location Address City Name:
CINCINNATI
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45241-2563
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
513-259-2488
Provider Business Practice Location Address Fax Number:
513-259-2487
Provider Enumeration Date:
09/23/2008

Additional Information

Authorized Official

Authorized Official Last Name:
JEFFREY
Authorized Official First Name:
JARRELL
Authorized Official Middle Name:
OTTIE
Authorized Official Title or Position:
MANAGING MEMBER OF LLC
Authorized Official Telephone Number:
859-331-8326

Provider Taxonomy Codes

  • Taxonomy code: 367500000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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