Provider Demographics
NPI:1396715363
Name:TRI-COUNTY ANESTHESIA INC
Entity type:Organization
Organization Name:TRI-COUNTY ANESTHESIA INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AGENT
Authorized Official - Prefix:MR
Authorized Official - First Name:NATHANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:NOBLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-451-7346
Mailing Address - Street 1:PO BOX 20451
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43220
Mailing Address - Country:US
Mailing Address - Phone:614-451-7346
Mailing Address - Fax:614-451-5846
Practice Address - Street 1:981 WOOSTER RD
Practice Address - Street 2:
Practice Address - City:MILLERSBURG
Practice Address - State:OH
Practice Address - Zip Code:44654
Practice Address - Country:US
Practice Address - Phone:614-451-7346
Practice Address - Fax:614-451-5846
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-24
Last Update Date:2008-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35054628K207L00000X
OH35049311A207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0882326Medicaid
C03158Medicare UPIN
9251291Medicare PIN
A15458Medicare UPIN