Provider Demographics
NPI:1164859013
Name:ANESTHESIA & INTENSIVE CARE CONSULTANTS,INC.
Entity Type:Organization
Organization Name:ANESTHESIA & INTENSIVE CARE CONSULTANTS,INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LEE
Authorized Official - Middle Name:STEPHEN
Authorized Official - Last Name:MEGOIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:859-341-7246
Mailing Address - Street 1:20 MEDICAL VILLAGE DR STE 258
Mailing Address - Street 2:
Mailing Address - City:EDGEWOOD
Mailing Address - State:KY
Mailing Address - Zip Code:41017-5411
Mailing Address - Country:US
Mailing Address - Phone:859-341-7246
Mailing Address - Fax:859-341-7867
Practice Address - Street 1:3000 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:BATAVIA
Practice Address - State:OH
Practice Address - Zip Code:45103-1921
Practice Address - Country:US
Practice Address - Phone:859-341-7246
Practice Address - Fax:859-341-7867
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-08
Last Update Date:2013-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty
No367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0713419Medicaid
KY74900564Medicaid
KY65934903Medicaid
000000011498OtherANTHEM BLUE CROSS BLUE SHIELD
IN200366350AMedicaid
FL914338600Medicaid
=========00OtherBUREAU WORKERS COMP GROUP
AN7900891Medicare PIN