Basic Information
| Provider Information | |||||||||
| NPI: | 1154473494 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PREMIER ANESTHESIOLOGISTS, LTD. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 14845 | ||||||||
| Address2: | |||||||||
| City: | COLUMBUS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 432140845 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6147611255 | ||||||||
| FaxNumber: | 6147610849 | ||||||||
| Practice Location | |||||||||
| Address1: | 930 BETHEL RD | ||||||||
| Address2: | |||||||||
| City: | COLUMBUS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 432141906 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6144510500 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/17/2007 | ||||||||
| LastUpdateDate: | 10/21/2013 | ||||||||
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| AuthorizedOfficialLastName: | FARINA | ||||||||
| AuthorizedOfficialFirstName: | RALPH | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 6144510500 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNameSuffix: | JR. | ||||||||
| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | 2077872 | 05 | OH | MEDICAID |