Provider Demographics
NPI:1467460303
Name:HAINES, BARRY L (CRNA)
Entity type:Individual
Prefix:MR
First Name:BARRY
Middle Name:L
Last Name:HAINES
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 SAINT CLAIR AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT MARYS
Mailing Address - State:OH
Mailing Address - Zip Code:45885-2400
Mailing Address - Country:US
Mailing Address - Phone:419-394-3335
Mailing Address - Fax:419-394-8485
Practice Address - Street 1:2793 SHAWNEE RD
Practice Address - Street 2:
Practice Address - City:LIMA
Practice Address - State:OH
Practice Address - Zip Code:45806-1444
Practice Address - Country:US
Practice Address - Phone:419-879-3636
Practice Address - Fax:419-879-4312
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2020-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA08569-NA367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHP00277590OtherRAILROAD MEDICARE
OH2613032Medicaid
OH000000679179OtherANTHEM
OHP00277590OtherRAILROAD MEDICARE
360032Medicare Oscar/Certification