Provider Demographics
NPI:1700920469
Name:CROSS COUNTRY ANESTHESIA, INC.
Entity Type:Organization
Organization Name:CROSS COUNTRY ANESTHESIA, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:LINCOLN
Authorized Official - Middle Name:DANIEL
Authorized Official - Last Name:GISEL
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:216-932-4522
Mailing Address - Street 1:2533 DERBYSHIRE RD
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND HTS
Mailing Address - State:OH
Mailing Address - Zip Code:44106-3230
Mailing Address - Country:US
Mailing Address - Phone:216-932-4522
Mailing Address - Fax:216-928-0141
Practice Address - Street 1:2533 DERBYSHIRE RD
Practice Address - Street 2:
Practice Address - City:CLEVELAND HTS
Practice Address - State:OH
Practice Address - Zip Code:44106-3230
Practice Address - Country:US
Practice Address - Phone:216-932-4522
Practice Address - Fax:216-928-0141
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH050966367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH00216277OtherRAILROAD MEDICARE
OH8230693Medicare ID - Type Unspecified
OH2222955Medicare ID - Type Unspecified