Provider Demographics
NPI:1619232451
Name:MERCY ANESTHESIA, INC
Entity Type:Organization
Organization Name:MERCY ANESTHESIA, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:THALES
Authorized Official - Middle Name:
Authorized Official - Last Name:PAVLATOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-408-9445
Mailing Address - Street 1:875 E JACKSON RD
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45502-7403
Mailing Address - Country:US
Mailing Address - Phone:317-385-2375
Mailing Address - Fax:
Practice Address - Street 1:100 W MAIN ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OH
Practice Address - Zip Code:45502-1312
Practice Address - Country:US
Practice Address - Phone:317-385-2375
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-09
Last Update Date:2012-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH13476284300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes284300000XHospitalsSpecial Hospital