Provider Demographics
NPI:1508040601
Name:LAKE ERIE ANESTHESIA INC
Entity Type:Organization
Organization Name:LAKE ERIE ANESTHESIA INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:J
Authorized Official - Last Name:FITZPATRICK
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:440-998-0000
Mailing Address - Street 1:2893 N RIDGE E
Mailing Address - Street 2:
Mailing Address - City:ASHTABULA
Mailing Address - State:OH
Mailing Address - Zip Code:44004-4134
Mailing Address - Country:US
Mailing Address - Phone:440-998-0000
Mailing Address - Fax:
Practice Address - Street 1:2893 N RIDGE E
Practice Address - Street 2:
Practice Address - City:ASHTABULA
Practice Address - State:OH
Practice Address - Zip Code:44004-4134
Practice Address - Country:US
Practice Address - Phone:440-998-0000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-26
Last Update Date:2008-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHDG8978OtherRAILROAD MEDICARE
OH2858288Medicaid
OHDG8978OtherRAILROAD MEDICARE