Provider Demographics
NPI:1407132830
Name:ANESTHESIA SERVICES OF GREATER DAYTON, LLC
Entity Type:Organization
Organization Name:ANESTHESIA SERVICES OF GREATER DAYTON, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:RIVIELLO
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:937-287-8178
Mailing Address - Street 1:4155-A LISA DR.
Mailing Address - Street 2:
Mailing Address - City:TIPP CITY
Mailing Address - State:OH
Mailing Address - Zip Code:45371-8425
Mailing Address - Country:US
Mailing Address - Phone:937-287-8178
Mailing Address - Fax:
Practice Address - Street 1:4235 INDIAN RIPPLE RD
Practice Address - Street 2:
Practice Address - City:BEAVERCREEK
Practice Address - State:OH
Practice Address - Zip Code:45440-3284
Practice Address - Country:US
Practice Address - Phone:937-427-2020
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-31
Last Update Date:2022-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty