Provider Demographics
NPI:1154407955
Name:CLEVELAND ANESTHESIA GROUP, INC.
Entity type:Organization
Organization Name:CLEVELAND ANESTHESIA GROUP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DOROTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:TIMMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:216-674-5230
Mailing Address - Street 1:6161 OAK TREE BLVD STE 270
Mailing Address - Street 2:
Mailing Address - City:INDEPENDENCE
Mailing Address - State:OH
Mailing Address - Zip Code:44131-2581
Mailing Address - Country:US
Mailing Address - Phone:216-674-5230
Mailing Address - Fax:216-674-5231
Practice Address - Street 1:6161 OAK TREE BLVD STE 270
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:OH
Practice Address - Zip Code:44131-2581
Practice Address - Country:US
Practice Address - Phone:216-674-5230
Practice Address - Fax:216-674-5231
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-27
Last Update Date:2023-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH417068207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1563213Medicaid
OH0206921OtherDEPT OF LABOR
OHCF6605OtherRAILROAD
OH=========-00OtherWORKERS COMP
OHCF6605OtherRAILROAD
OH0206921OtherDEPT OF LABOR
OH1563213Medicaid