Provider Demographics
NPI:1487662300
Name:ANESTHESIA ASSOCIATES OF LIMA INC
Entity Type:Organization
Organization Name:ANESTHESIA ASSOCIATES OF LIMA INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:W
Authorized Official - Last Name:MOON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:419-222-0328
Mailing Address - Street 1:PO BOX 71-0776
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43271-0776
Mailing Address - Country:US
Mailing Address - Phone:419-228-1506
Mailing Address - Fax:419-228-3352
Practice Address - Street 1:1001 BELLEFONTAINE AVENUE
Practice Address - Street 2:
Practice Address - City:LIMA
Practice Address - State:OH
Practice Address - Zip Code:45804-2895
Practice Address - Country:US
Practice Address - Phone:419-228-3335
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty
Not Answered207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty
Not Answered367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2152343Medicaid
OH000000169117OtherANTHEM
OH2152389Medicaid
OH2151979Medicaid
OHCH3533OtherRAILROAD MEDICARE
OH2152389Medicaid
OH=========005OtherTRICARE
OH=========03OtherWORKERS COMPENSATION
OH=========01OtherWORKERS COMPENSATION
OHCH3533OtherRAILROAD MEDICARE
OH2151979Medicaid
OH9307511Medicare ID - Type Unspecified