Provider Demographics
NPI:1164488771
Name:WALSH, JOE L (CRNA)
Entity Type:Individual
Prefix:
First Name:JOE
Middle Name:L
Last Name:WALSH
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:660 ACKERMAN 3RD FLOOR
Mailing Address - Street 2:PO BOX 183103
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43216-3103
Mailing Address - Country:US
Mailing Address - Phone:614-293-2160
Mailing Address - Fax:614-293-8479
Practice Address - Street 1:410 WEST TENTH AVENUE
Practice Address - Street 2:N429 DOAN HALL
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43210
Practice Address - Country:US
Practice Address - Phone:614-293-4705
Practice Address - Fax:614-293-8163
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OHNA02787367500000X
OHRN230376367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2065143Medicaid
OH2065143Medicaid
WA8221533Medicare ID - Type Unspecified