Basic Information
| Provider Information | |||||||||
| NPI: | 1437292174 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PREMIER ANESTHESIA OF BOARDMAN A | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 235022 | ||||||||
| Address2: | |||||||||
| City: | MONTGOMERY | ||||||||
| State: | AL | ||||||||
| PostalCode: | 361235022 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3343862055 | ||||||||
| FaxNumber: | 3343966929 | ||||||||
| Practice Location | |||||||||
| Address1: | 6505 MARKET ST BLDG D | ||||||||
| Address2: | |||||||||
| City: | BOARDMAN | ||||||||
| State: | OH | ||||||||
| PostalCode: | 445123459 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3308842100 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/14/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | SOBOL | ||||||||
| AuthorizedOfficialFirstName: | BARBARA | ||||||||
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| AuthorizedOfficialTitleorPosition: | OPERATIONS COORDINATOR | ||||||||
| AuthorizedOfficialTelephone: | 7706435563 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | OH | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology |
No ID Information.