Provider Demographics
NPI:1720101934
Name:OFFICE ANESTHESIA SERVICE LLC
Entity Type:Organization
Organization Name:OFFICE ANESTHESIA SERVICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:DUANE
Authorized Official - Last Name:HILL
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:501-328-7648
Mailing Address - Street 1:PO BOX 20451
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43220-0451
Mailing Address - Country:US
Mailing Address - Phone:614-451-7346
Mailing Address - Fax:614-451-5846
Practice Address - Street 1:1730 GALLERIA OAKS DR
Practice Address - Street 2:
Practice Address - City:TEXARKANA
Practice Address - State:TX
Practice Address - Zip Code:75503-4649
Practice Address - Country:US
Practice Address - Phone:903-793-6780
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARR31688367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
=========OtherFEIN