Provider Demographics
NPI:1750352159
Name:MONT GREEN ANESTHESIOLOGY INC
Entity type:Organization
Organization Name:MONT GREEN ANESTHESIOLOGY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:D
Authorized Official - Last Name:KAMINSKI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:937-297-6072
Mailing Address - Street 1:3180 KETTERING BLVD
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45439-1924
Mailing Address - Country:US
Mailing Address - Phone:937-297-6072
Mailing Address - Fax:937-293-0969
Practice Address - Street 1:707 S. EDWIN C. MOSES BLVD.
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45408-1462
Practice Address - Country:US
Practice Address - Phone:937-221-8000
Practice Address - Fax:937-221-8529
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-01
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty
No367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2600573Medicaid
OH2600555Medicaid
OH2600546Medicaid
OH2600564Medicaid
OH000000381907OtherANTHEM
OHDD8829OtherRAILROAD MEDICARE
OH565255007005OtherMEDICAL MUTUAL OF OHIO
OH2600537Medicaid
OHDD8829OtherRAILROAD MEDICARE
OH000000381907OtherANTHEM
OH=========004OtherMEDICAL MUTUAL OF OHIO
OH2600564Medicaid
OH2600537Medicaid
OH=========002OtherMEDICAL MUTUAL OF OHIO
OH=========01OtherWORKERS COMPENSATION
OH2600555Medicaid
OH2600537Medicaid