Provider Demographics
NPI:1063497402
Name:TOON, THOMAS H (CRNA)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:H
Last Name:TOON
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:L-6147
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45272-6147
Mailing Address - Country:US
Mailing Address - Phone:859-341-7246
Mailing Address - Fax:859-341-7867
Practice Address - Street 1:7500 STATE RD
Practice Address - Street 2:ANESTHESIA INTENSIVE CARE CONSULTANTS INC
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45255-2439
Practice Address - Country:US
Practice Address - Phone:859-341-7246
Practice Address - Fax:859-341-7867
Is Sole Proprietor?:No
Enumeration Date:2005-12-08
Last Update Date:2011-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH170575163W00000X
OH047615367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000259043OtherANTHEM
OH2092220Medicaid
KY74005919Medicaid
728037OtherBUCKEYE
IN200422640Medicaid
KY617721OtherWELLCARE
000000259043OtherANTHEM BLUE SHIELD
430048268Medicare PIN
728037OtherBUCKEYE
KY74005919Medicaid
000000259043OtherANTHEM BLUE SHIELD