Basic Information
| Provider Information | |||||||||
| NPI: | 1639248784 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CARDIAC ANESTHESIA ASSOCIATES LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 414 | ||||||||
| Address2: | |||||||||
| City: | BLACKLICK | ||||||||
| State: | OH | ||||||||
| PostalCode: | 430040414 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6145520061 | ||||||||
| FaxNumber: | 6145520168 | ||||||||
| Practice Location | |||||||||
| Address1: | 1000 MCKINLEY PARK DR | ||||||||
| Address2: | |||||||||
| City: | MARION | ||||||||
| State: | OH | ||||||||
| PostalCode: | 43302 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6145520061 | ||||||||
| FaxNumber: | 6145520168 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/06/2006 | ||||||||
| LastUpdateDate: | 07/17/2007 | ||||||||
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| AuthorizedOfficialLastName: | WILLIAMS | ||||||||
| AuthorizedOfficialFirstName: | TERI | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | CREDENTIALISTS | ||||||||
| AuthorizedOfficialTelephone: | 6145520061 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology |
No ID Information.