Provider Demographics
NPI:1558322388
Name:PREMIER ANESTHESIA OF PARMA
Entity Type:Organization
Organization Name:PREMIER ANESTHESIA OF PARMA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GROUP MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:
Authorized Official - Last Name:BARRON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:334-396-6930
Mailing Address - Street 1:PO BOX 235022
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36123-5022
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7007 POWERS BLVD
Practice Address - Street 2:
Practice Address - City:PARMA
Practice Address - State:OH
Practice Address - Zip Code:44129-5437
Practice Address - Country:US
Practice Address - Phone:440-743-4000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2581111Medicaid
OHPR9354641Medicare ID - Type UnspecifiedMEDICARE GROUP #