Provider Demographics
NPI:1891848776
Name:PROFESSIONAL ANESTHESIA ASSOCIATES, INC.
Entity Type:Organization
Organization Name:PROFESSIONAL ANESTHESIA ASSOCIATES, INC.
Other - Org Name:MIDOHIO PAINCARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:R
Authorized Official - Last Name:WOLFE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:419-756-4004
Mailing Address - Street 1:605 S TRIMBLE RD STE B
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44906-4112
Mailing Address - Country:US
Mailing Address - Phone:419-756-4004
Mailing Address - Fax:419-756-4060
Practice Address - Street 1:605 S TRIMBLE RD STE B
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:OH
Practice Address - Zip Code:44906-4112
Practice Address - Country:US
Practice Address - Phone:419-756-4004
Practice Address - Fax:419-756-4060
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-22
Last Update Date:2016-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1912985094OtherPHYSICIAN MPI
OH0126947Medicaid
OH1689606295OtherPHYSICIAN NPI
OH1912985094OtherPHYSICIAN MPI
OH1689606295OtherPHYSICIAN NPI
OH104350Medicare UPIN
OH1912985094OtherPHYSICIAN MPI
OH104350Medicare UPIN
OH0126947Medicare ID - Type UnspecifiedGROUP NUMBER
OH1689606295OtherPHYSICIAN NPI