Provider Demographics
NPI:1598703951
Name:MIDWEST PHYSICIAN ANESTHESIA SERVICES, INC.
Entity Type:Organization
Organization Name:MIDWEST PHYSICIAN ANESTHESIA SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:EILEEN
Authorized Official - Middle Name:M
Authorized Official - Last Name:KROTINE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-457-2306
Mailing Address - Street 1:5151 REED ROAD
Mailing Address - Street 2:SUITE 225-C
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43220-2595
Mailing Address - Country:US
Mailing Address - Phone:614-884-0641
Mailing Address - Fax:614-884-0776
Practice Address - Street 1:5151 REED ROAD
Practice Address - Street 2:SUITE 225-C
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43220-2595
Practice Address - Country:US
Practice Address - Phone:614-884-0641
Practice Address - Fax:614-884-0776
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-04
Last Update Date:2015-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH207L00000X, 367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
No367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHCI0498OtherRAILROAD MEDICARE
OHC10498OtherRAILROAD MEDICARE
OH0889203Medicaid
OH0889203Medicaid
OH8000401Medicare PIN