Provider Demographics
NPI:1760432454
Name:MALABAR ANESTHESIA SERVICES LTD
Entity Type:Organization
Organization Name:MALABAR ANESTHESIA SERVICES LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:M
Authorized Official - Last Name:GRAHAM
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:419-566-4152
Mailing Address - Street 1:PO BOX 182255
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43218-2255
Mailing Address - Country:US
Mailing Address - Phone:614-430-5764
Mailing Address - Fax:
Practice Address - Street 1:3300 WELTY RD
Practice Address - Street 2:
Practice Address - City:LUCAS
Practice Address - State:OH
Practice Address - Zip Code:44843-9729
Practice Address - Country:US
Practice Address - Phone:419-566-4152
Practice Address - Fax:419-842-3875
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-11
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CB6800OtherMEDICARE RAILROAD
OH2298606Medicaid
CB6800OtherMEDICARE RAILROAD
CB6800OtherMEDICARE RAILROAD