Basic Information
| Provider Information | |||||||||
| NPI: | 1477927531 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BRECKSVILLE ANESTHESIA, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7001 S EDGERTON RD | ||||||||
| Address2: | STE A | ||||||||
| City: | BRECKSVILLE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 441414206 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4407170491 | ||||||||
| FaxNumber: | 4407170594 | ||||||||
| Practice Location | |||||||||
| Address1: | 7001 S EDGERTON RD | ||||||||
| Address2: | STE A | ||||||||
| City: | BRECKSVILLE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 441414206 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4407170491 | ||||||||
| FaxNumber: | 4407170594 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/30/2015 | ||||||||
| LastUpdateDate: | 11/30/2015 | ||||||||
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| AuthorizedOfficialLastName: | WILEY | ||||||||
| AuthorizedOfficialFirstName: | WILLIAM | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 4408402020 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | Y | 193400000X SINGLE SPECIALTY GROUP | Other Service Providers | Specialist |
No ID Information.