Basic Information
Provider Information
NPI: 1700100419
EntityType: 2
ReplacementNPI:  
OrganizationName: SOUTH CENTRAL OHIO ANESTHESIA LLC
LastName:  
FirstName:  
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 601 WASHINGTON AVE
Address2: SUITE 390
City: NEWPORT
State: KY
PostalCode: 410711986
CountryCode: US
TelephoneNumber: 8596558554
FaxNumber:  
Practice Location
Address1: 601 STATE ROUTE 664 N
Address2:  
City: LOGAN
State: OH
PostalCode: 431388541
CountryCode: US
TelephoneNumber: 7409830397
FaxNumber:  
Other Information
ProviderEnumerationDate: 03/24/2010
LastUpdateDate: 06/24/2010
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode:  
AuthorizedOfficialLastName: VEITH
AuthorizedOfficialFirstName: JON
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition: OWNER/PRESIDENT
AuthorizedOfficialTelephone: 7409830397
IsSoleProprietor:  
IsOrganizationSubpart: N
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential: CRNA
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207L00000XCOA.02437-NAOHY193400000X SINGLE SPECIALTY GROUPAllopathic & Osteopathic PhysiciansAnesthesiology 

ID Information
IDTypeStateIssuerDescription
125530316001OHINDIVIDUAL NPIOTHER


Home