Basic Information
Provider Information | |||||||||
NPI: | 1760435168 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | LABABIDI ENTERPRISES INC. | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: | DBA: OHIO ANESTHESIA ASSOCIATES | ||||||||
OtherOrganizationType: | 3 | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 2215 E WATERLOO RD | ||||||||
Address2: | SUITE 313 | ||||||||
City: | AKRON | ||||||||
State: | OH | ||||||||
PostalCode: | 443123856 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3302082720 | ||||||||
FaxNumber: | 3302082721 | ||||||||
Practice Location | |||||||||
Address1: | 1560 CORPORATE WOODS PKWY | ||||||||
Address2: |   | ||||||||
City: | UNIONTOWN | ||||||||
State: | OH | ||||||||
PostalCode: | 446858730 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3302082720 | ||||||||
FaxNumber: | 3302082721 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 05/18/2006 | ||||||||
LastUpdateDate: | 07/24/2020 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | LABABIDI | ||||||||
AuthorizedOfficialFirstName: | WALID | ||||||||
AuthorizedOfficialMiddleName: | G | ||||||||
AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
AuthorizedOfficialTelephone: | 3302082720 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: | MR. | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: | CRNA | ||||||||
NPICertificationDate: | 07/24/2020 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207LP2900X |   |   | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology | Pain Medicine |
ID Information
ID | Type | State | Issuer | Description | 2104743 | 05 | OH |   | MEDICAID |