Basic Information
| Provider Information | |||||||||
| NPI: | 1699764712 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PRIME ANESTHESIA CONSULTANTS INC. | ||||||||
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| OtherOrganizationName: | GROVE CITY PAIN MANAGEMENT GROUP | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1699 WASHINGTON RD | ||||||||
| Address2: | SUITE 307 | ||||||||
| City: | PITTSBURGH | ||||||||
| State: | PA | ||||||||
| PostalCode: | 152281629 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4128313744 | ||||||||
| FaxNumber: | 4128315663 | ||||||||
| Practice Location | |||||||||
| Address1: | 118 S CENTER ST | ||||||||
| Address2: | |||||||||
| City: | GROVE CITY | ||||||||
| State: | PA | ||||||||
| PostalCode: | 161271507 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7242644303 | ||||||||
| FaxNumber: | 7242644305 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/20/2005 | ||||||||
| LastUpdateDate: | 09/08/2010 | ||||||||
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| AuthorizedOfficialLastName: | TAIWO | ||||||||
| AuthorizedOfficialFirstName: | OLAKUNLE | ||||||||
| AuthorizedOfficialMiddleName: | O | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 4128313744 | ||||||||
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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 | 207LP2900X | MD067051L | PA | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology | Pain Medicine |
No ID Information.