Provider Demographics
NPI:1841230703
Name:MARIETTA ANESTHESIA CARE, INC.
Entity Type:Organization
Organization Name:MARIETTA ANESTHESIA CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:D
Authorized Official - Last Name:CANTONI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:740-374-1400
Mailing Address - Street 1:PO BOX 74973
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44194-1056
Mailing Address - Country:US
Mailing Address - Phone:614-430-5727
Mailing Address - Fax:
Practice Address - Street 1:401 MATTHEW ST
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:OH
Practice Address - Zip Code:45750-1635
Practice Address - Country:US
Practice Address - Phone:740-374-1400
Practice Address - Fax:740-568-5330
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-08
Last Update Date:2007-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810000378Medicaid
OH2474586Medicaid
DB7710OtherMEDICARE RAILROAD
WV3810000378Medicaid