Provider Demographics
NPI:1225079270
Name:BUCKEYE ANESTHESIA SERVICES & CONSULTANTS LLC
Entity Type:Organization
Organization Name:BUCKEYE ANESTHESIA SERVICES & CONSULTANTS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:A
Authorized Official - Last Name:WANGLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:419-224-7586
Mailing Address - Street 1:PO BOX 714813
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43271-4813
Mailing Address - Country:US
Mailing Address - Phone:937-293-0247
Mailing Address - Fax:937-293-0969
Practice Address - Street 1:801 MEDICAL DR
Practice Address - Street 2:SUITE A
Practice Address - City:LIMA
Practice Address - State:OH
Practice Address - Zip Code:45804-4099
Practice Address - Country:US
Practice Address - Phone:419-224-7586
Practice Address - Fax:419-224-9769
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-09
Last Update Date:2022-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2460457Medicaid
OHDB0764OtherRAILROAD MEDICARE
125460100OtherFEDERAL WORKERS COMP ACS
OH000000318057OtherANTHEM
OH000000318057OtherANTHEM
OH=========00OtherWORKERS COMP