Provider Demographics
NPI:1518614122
Name:SOUTHWEST OHIO ANESTHETISTS
Entity Type:Organization
Organization Name:SOUTHWEST OHIO ANESTHETISTS
Other - Org Name:SOUTHWEST OHIO ANESTHETISTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TRICIA
Authorized Official - Middle Name:K
Authorized Official - Last Name:CROAKE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:513-608-8562
Mailing Address - Street 1:PO BOX 7096
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95267-0096
Mailing Address - Country:US
Mailing Address - Phone:877-866-9877
Mailing Address - Fax:209-956-7733
Practice Address - Street 1:5700 GATEWAY STE 100
Practice Address - Street 2:
Practice Address - City:MASON
Practice Address - State:OH
Practice Address - Zip Code:45040-1890
Practice Address - Country:US
Practice Address - Phone:513-229-7800
Practice Address - Fax:513-229-7888
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-03
Last Update Date:2022-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty