1255768107 NPI number — SOUTHWEST OHIO ANESTHESIA CONSULTANTS LLC

Table of content: (NPI 1255768107)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255768107 NPI number — SOUTHWEST OHIO ANESTHESIA CONSULTANTS LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SOUTHWEST OHIO ANESTHESIA CONSULTANTS 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:
ANESTHESIA & INTENSIVE CARE CONSULTANTS, INC.
Provider Other Organization Name Type Code:
4
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:
1255768107
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/04/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4665 CORNELL RD STE 119
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BLUE ASH
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45241-2455
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
513-265-5989
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4415 AICHOLTZ RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CINCINNATI
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45245-1506
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-341-7246
Provider Business Practice Location Address Fax Number:
859-341-7867
Provider Enumeration Date:
10/08/2013

Additional Information

Authorized Official

Authorized Official Last Name:
MEGOIS
Authorized Official First Name:
LEE
Authorized Official Middle Name:
STEPHEN
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
859-341-7246

Provider Taxonomy Codes

  • Taxonomy code: 207L00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 367500000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 74900564 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0713419 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 914338600 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000000011498 . This is a "ANTHEM BLUE CROSS BLUE SHIELD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 65934903 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200366350A , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com