Provider Demographics
NPI:1477965150
Name:MASK ANESTHESIA CONSULTANTS INC
Entity Type:Organization
Organization Name:MASK ANESTHESIA CONSULTANTS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:W
Authorized Official - Last Name:STANLEY
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:614-751-4466
Mailing Address - Street 1:PO BOX 713960
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45271-3960
Mailing Address - Country:US
Mailing Address - Phone:614-751-4466
Mailing Address - Fax:614-751-4474
Practice Address - Street 1:275 TAYLOR STATION RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43213-1445
Practice Address - Country:US
Practice Address - Phone:614-751-4466
Practice Address - Fax:614-751-4474
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-29
Last Update Date:2019-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH201412900247207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH201412900247OtherSTATE OF OHIO CERTIFICATE