Provider Demographics
NPI:1063493948
Name:OHIO VALLEY ANESTHESIA LLC
Entity Type:Organization
Organization Name:OHIO VALLEY ANESTHESIA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LEE
Authorized Official - Middle Name:STACY
Authorized Official - Last Name:MEGOIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:859-341-7246
Mailing Address - Street 1:PO BOX 70-1618
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45270-1618
Mailing Address - Country:US
Mailing Address - Phone:859-341-7246
Mailing Address - Fax:859-341-7867
Practice Address - Street 1:3131 QUEEN CITY AVE
Practice Address - Street 2:OHIO VALLEY ANESTHESIA LLC
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45238-2316
Practice Address - Country:US
Practice Address - Phone:859-341-7246
Practice Address - Fax:859-341-7867
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-08
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
No367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY65936775OtherPHYSICIANS MEDICAID
KY74900416OtherCRNAS MEDICAID
OH2361831Medicaid
OH2361868Medicaid
=========00OtherBUREAU WORKERS COMP
KY65936775OtherPHYSICIANS MEDICAID
KY74900416OtherCRNAS MEDICAID
OHOH9322272Medicare ID - Type UnspecifiedGROUP NUMBER
=========OtherTAX ID