Provider Demographics
NPI:1790733566
Name:EASTSIDE ANESTHESIA GROUP
Entity Type:Organization
Organization Name:EASTSIDE ANESTHESIA GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:G.
Authorized Official - Middle Name:GARTH
Authorized Official - Last Name:GRANT
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:440-729-8221
Mailing Address - Street 1:8251 MAYFIELD RD STE 23
Mailing Address - Street 2:
Mailing Address - City:CHESTERLAND
Mailing Address - State:OH
Mailing Address - Zip Code:44026-2567
Mailing Address - Country:US
Mailing Address - Phone:440-729-8221
Mailing Address - Fax:440-729-7896
Practice Address - Street 1:8251 MAYFIELD RD STE 23
Practice Address - Street 2:
Practice Address - City:CHESTERLAND
Practice Address - State:OH
Practice Address - Zip Code:44026-2567
Practice Address - Country:US
Practice Address - Phone:440-729-8221
Practice Address - Fax:440-729-7896
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-04
Last Update Date:2010-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty
No367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2376665Medicare ID - Type Unspecified
OHEA9324471Medicare ID - Type Unspecified