Provider Demographics
NPI:1083992374
Name:WESTERN RESERVE ANESTHESIA ASSOCIATES INC
Entity Type:Organization
Organization Name:WESTERN RESERVE ANESTHESIA ASSOCIATES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:E
Authorized Official - Last Name:MOLTER
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:440-478-8448
Mailing Address - Street 1:10335 PINECREST RD
Mailing Address - Street 2:
Mailing Address - City:CONCORD TWP
Mailing Address - State:OH
Mailing Address - Zip Code:44077-8814
Mailing Address - Country:US
Mailing Address - Phone:440-478-8448
Mailing Address - Fax:
Practice Address - Street 1:1709 MEDICAL BLVD
Practice Address - Street 2:
Practice Address - City:FINDLAY
Practice Address - State:OH
Practice Address - Zip Code:45840-1398
Practice Address - Country:US
Practice Address - Phone:419-429-0409
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-03
Last Update Date:2011-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207L00000X
OHM34005687207L00000X
OHRN.248071-COA1367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty