Provider Demographics
NPI:1740599976
Name:SAFE ANESTHESIA CHARDON LLC
Entity Type:Organization
Organization Name:SAFE ANESTHESIA CHARDON LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED REPRESENTATIVE
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:M
Authorized Official - Last Name:CRAKER
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:440-285-2900
Mailing Address - Street 1:356 MINER RD
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND HTS
Mailing Address - State:OH
Mailing Address - Zip Code:44143-1537
Mailing Address - Country:US
Mailing Address - Phone:404-285-2900
Mailing Address - Fax:
Practice Address - Street 1:255 W MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49201-2218
Practice Address - Country:US
Practice Address - Phone:517-787-6440
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-06
Last Update Date:2010-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Multi-Specialty