Provider Demographics
NPI:1184874869
Name:PENN-OHIO ASSOCIATES IN ANESTHESIOLOGY, LLC
Entity type:Organization
Organization Name:PENN-OHIO ASSOCIATES IN ANESTHESIOLOGY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:FREDERICK
Authorized Official - Middle Name:G
Authorized Official - Last Name:KURZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:330-559-1002
Mailing Address - Street 1:4135 BOARDMAN CANFIELD RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:CANFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44406-9803
Mailing Address - Country:US
Mailing Address - Phone:330-286-5330
Mailing Address - Fax:330-286-5396
Practice Address - Street 1:740 E STATE ST
Practice Address - Street 2:
Practice Address - City:SHARON
Practice Address - State:PA
Practice Address - Zip Code:16146-3328
Practice Address - Country:US
Practice Address - Phone:724-983-7310
Practice Address - Fax:724-983-2797
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-30
Last Update Date:2015-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2926918Medicaid
OHPENDINGOtherMEDICARE PTAN
PA2077504OtherHIGHMARK BLUE SHIELD
PA1022302180001Medicaid
7281868OtherCIGNA
614321800OtherUS DEPARTMENT OF LABOR
OHPENDINGOtherMEDICARE PTAN