Provider Demographics
NPI:1912295684
Name:DG ANESTHESIA, LLC
Entity Type:Organization
Organization Name:DG ANESTHESIA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:W
Authorized Official - Last Name:PENNO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-320-5088
Mailing Address - Street 1:75 SYLVANIA DR
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45440-3237
Mailing Address - Country:US
Mailing Address - Phone:937-320-5050
Mailing Address - Fax:937-320-5060
Practice Address - Street 1:75 SYLVANIA DR
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45440-3237
Practice Address - Country:US
Practice Address - Phone:937-320-5050
Practice Address - Fax:937-320-5060
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-15
Last Update Date:2013-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHH071150OtherMEDICARE PTAN