Provider Demographics
NPI:1508894213
Name:SOUTHWOODS ANESTHESIA INC
Entity Type:Organization
Organization Name:SOUTHWOODS ANESTHESIA INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:J
Authorized Official - Last Name:PRIZANT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:330-758-1954
Mailing Address - Street 1:PO BOX 182255
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43218-2255
Mailing Address - Country:US
Mailing Address - Phone:614-430-5724
Mailing Address - Fax:
Practice Address - Street 1:7525 CALIFORNIA AVE
Practice Address - Street 2:
Practice Address - City:BOARDMAN
Practice Address - State:OH
Practice Address - Zip Code:44512-5623
Practice Address - Country:US
Practice Address - Phone:330-758-1954
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-29
Last Update Date:2007-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA01644648Medicaid
CD5178OtherMEDICARE RAILROAD
OH0256646Medicaid
PA01644648Medicaid