Provider Demographics
NPI:1134137052
Name:REIDENBACH, ADAM (CRNA)
Entity Type:Individual
Prefix:MR
First Name:ADAM
Middle Name:
Last Name:REIDENBACH
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:PO BOX 71-0776
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43271-0776
Mailing Address - Country:US
Mailing Address - Phone:419-228-1506
Mailing Address - Fax:419-228-3352
Practice Address - Street 1:730 W MARKET STREET
Practice Address - Street 2:
Practice Address - City:LIMA
Practice Address - State:OH
Practice Address - Zip Code:45801
Practice Address - Country:US
Practice Address - Phone:419-227-3361
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN282678367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000377212OtherANTHEM
OHP00277592OtherRAILROAD MEDICARE
OH2608744Medicaid
OHP00277592OtherRAILROAD MEDICARE