Basic Information
| Provider Information | |||||||||
| NPI: | 1003270992 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NORTHSTAR ANESTHESIA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6129 CHIDESTER DR | ||||||||
| Address2: | |||||||||
| City: | CANFIELD | ||||||||
| State: | OH | ||||||||
| PostalCode: | 444069749 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 1995 E STATE ST | ||||||||
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| City: | SALEM | ||||||||
| State: | OH | ||||||||
| PostalCode: | 444602423 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3303321551 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/07/2016 | ||||||||
| LastUpdateDate: | 04/07/2016 | ||||||||
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| AuthorizedOfficialLastName: | KYLE | ||||||||
| AuthorizedOfficialFirstName: | ADAM | ||||||||
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| AuthorizedOfficialTitleorPosition: | CRNA | ||||||||
| AuthorizedOfficialTelephone: | 3306510055 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282N00000X | Y | Hospitals | General Acute Care Hospital |
No ID Information.