Basic Information
| Provider Information | |||||||||
| NPI: | 1194800425 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MCGUIRE | ||||||||
| FirstName: | HENRY | ||||||||
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| Credential: | CRNA | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 20452 | ||||||||
| Address2: | |||||||||
| City: | COLUMBUS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 432200452 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6144422410 | ||||||||
| FaxNumber: | 6144422406 | ||||||||
| Practice Location | |||||||||
| Address1: | 500 S CLEVELAND AVE | ||||||||
| Address2: | COA-CREDENTIALING | ||||||||
| City: | WESTERVILLE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 430818971 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6148986659 | ||||||||
| FaxNumber: | 6148988631 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/26/2006 | ||||||||
| LastUpdateDate: | 11/05/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | RN188647COA1 | OH | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
ID Information
| ID | Type | State | Issuer | Description | 2044693 | 05 | OH | MEDICAID |