Provider Demographics
NPI:1922249952
Name:EAST LIVERPOOL SPECIALTY ANESTHESIA LLC
Entity Type:Organization
Organization Name:EAST LIVERPOOL SPECIALTY ANESTHESIA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:WHITEHEAD
Authorized Official - Last Name:KEARNS
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:330-332-9094
Mailing Address - Street 1:15613 PINEVIEW DR
Mailing Address - Street 2:SUITE C
Mailing Address - City:EAST LIVERPOOL
Mailing Address - State:OH
Mailing Address - Zip Code:43920-9096
Mailing Address - Country:US
Mailing Address - Phone:330-332-9094
Mailing Address - Fax:330-382-1154
Practice Address - Street 1:15613 PINEVIEW DR
Practice Address - Street 2:SUITE C
Practice Address - City:EAST LIVERPOOL
Practice Address - State:OH
Practice Address - Zip Code:43920-9096
Practice Address - Country:US
Practice Address - Phone:330-332-9094
Practice Address - Fax:330-382-1154
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-22
Last Update Date:2009-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH251756367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty