Provider Demographics
NPI:1649577016
Name:OFFICE BASED ANESTHESIA SERVICES, LLC
Entity Type:Organization
Organization Name:OFFICE BASED ANESTHESIA SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:J
Authorized Official - Last Name:KASSON
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:513-791-3618
Mailing Address - Street 1:400 E 10TH ST
Mailing Address - Street 2:
Mailing Address - City:WACONIA
Mailing Address - State:MN
Mailing Address - Zip Code:55387-4552
Mailing Address - Country:US
Mailing Address - Phone:952-442-9770
Mailing Address - Fax:952-442-3620
Practice Address - Street 1:4834 SOCIALVILLE FOSTER RD
Practice Address - Street 2:SUITE 160
Practice Address - City:MASON
Practice Address - State:OH
Practice Address - Zip Code:45040-6827
Practice Address - Country:US
Practice Address - Phone:952-442-9770
Practice Address - Fax:952-442-3620
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-22
Last Update Date:2011-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty