Provider Demographics
NPI:1669432084
Name:ASHLAND ANESTHESIA, PSC. INC.
Entity type:Organization
Organization Name:ASHLAND ANESTHESIA, PSC. INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:419-289-0491
Mailing Address - Street 1:1025 CENTER ST
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:OH
Mailing Address - Zip Code:44805-4011
Mailing Address - Country:US
Mailing Address - Phone:419-289-0491
Mailing Address - Fax:
Practice Address - Street 1:1025 CENTER ST
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:OH
Practice Address - Zip Code:44805-4011
Practice Address - Country:US
Practice Address - Phone:419-289-0491
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-28
Last Update Date:2008-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2226120Medicaid
CH9190Medicare PIN
OH9314421Medicare PIN