Provider Demographics
NPI:1417951948
Name:ANESTHESIA GROUP PRACTICE, INC
Entity Type:Organization
Organization Name:ANESTHESIA GROUP PRACTICE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:GROSSMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-817-1150
Mailing Address - Street 1:PO BOX 632572
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-2572
Mailing Address - Country:US
Mailing Address - Phone:859-341-2666
Mailing Address - Fax:859-341-7867
Practice Address - Street 1:10500 MONTGOMERY ROAD
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45242-4402
Practice Address - Country:US
Practice Address - Phone:513-817-1150
Practice Address - Fax:513-895-9124
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-13
Last Update Date:2019-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
No207LC0200XAllopathic & Osteopathic PhysiciansAnesthesiologyCritical Care MedicineGroup - Single Specialty
No367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY74900911Medicaid
KY7100392750Medicaid
IN100009200Medicaid
KY65942781Medicaid
OH4127751Medicaid
KY7100393520Medicaid
KY7100392750Medicaid
KY74900911Medicaid