Provider Demographics
NPI:1083607568
Name:WESTERN OHIO ANESTHESIA ASSOCIATES
Entity Type:Organization
Organization Name:WESTERN OHIO ANESTHESIA ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:C
Authorized Official - Last Name:GRAY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:513-524-5440
Mailing Address - Street 1:P O BOX 634036
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-0001
Mailing Address - Country:US
Mailing Address - Phone:513-524-5574
Mailing Address - Fax:
Practice Address - Street 1:110 N POPLAR ST
Practice Address - Street 2:MCCULLOUGH-HYDE MEMORIAL HOSPITAL ANESTHESIOLOGY DEPT
Practice Address - City:OXFORD
Practice Address - State:OH
Practice Address - Zip Code:45056-1204
Practice Address - Country:US
Practice Address - Phone:513-524-5574
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-30
Last Update Date:2019-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHDB2847OtherRR MEDICARE
OHDB2847OtherRR MEDICARE