Provider Demographics
NPI:1659364289
Name:ANESTHESIA ASSOCIATES OF NORTHERN OHIO, INC.
Entity Type:Organization
Organization Name:ANESTHESIA ASSOCIATES OF NORTHERN OHIO, INC.
Other - Org Name:ANESTHESIA ASSOCIATES OF NORTHERN OHIO, INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:LOIS
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:WULFHOOP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:440-233-8181
Mailing Address - Street 1:PO BOX 901681
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44190-0001
Mailing Address - Country:US
Mailing Address - Phone:440-233-8181
Mailing Address - Fax:440-233-8182
Practice Address - Street 1:6125 S BROADWAY
Practice Address - Street 2:
Practice Address - City:LORAIN
Practice Address - State:OH
Practice Address - Zip Code:44053-3820
Practice Address - Country:US
Practice Address - Phone:440-233-8181
Practice Address - Fax:440-233-8182
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-30
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0219543Medicaid
OH9281901Medicare PIN