Basic Information
| Provider Information | |||||||||
| NPI: | 1366441586 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CENTRAL OHIO ANESTHESIA INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | P O BOX 711052 | ||||||||
| Address2: | |||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452710001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6144578180 | ||||||||
| FaxNumber: | 6145833300 | ||||||||
| Practice Location | |||||||||
| Address1: | 500 S CLEVELAND AVE | ||||||||
| Address2: | ST. ANN'S HOSPITAL ANESTHESIA DEPT | ||||||||
| City: | WESTERVILLE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 430818971 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6148986659 | ||||||||
| FaxNumber: | 6148988631 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/19/2005 | ||||||||
| LastUpdateDate: | 09/16/2010 | ||||||||
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| AuthorizedOfficialLastName: | JOPLING | ||||||||
| AuthorizedOfficialFirstName: | MICHAEL | ||||||||
| AuthorizedOfficialMiddleName: | W. | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 6148986659 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered | 207L00000X | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | 2036737 | 05 | OH | MEDICAID | CN2887 | 01 | OH | RR MEDICARE | OTHER |