Provider Demographics
NPI:1154571586
Name:OFFICE BASED ANESTHESIA ASSOCIATES
Entity type:Organization
Organization Name:OFFICE BASED ANESTHESIA ASSOCIATES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER OF LLC
Authorized Official - Prefix:
Authorized Official - First Name:JARRELL
Authorized Official - Middle Name:OTTIE
Authorized Official - Last Name:JEFFREY
Authorized Official - Suffix:JR
Authorized Official - Credentials:CRNA
Authorized Official - Phone:859-331-8326
Mailing Address - Street 1:2604 MARLO WAY
Mailing Address - Street 2:
Mailing Address - City:LAKESIDE PARK
Mailing Address - State:KY
Mailing Address - Zip Code:41017-2150
Mailing Address - Country:US
Mailing Address - Phone:859-331-8326
Mailing Address - Fax:859-331-8326
Practice Address - Street 1:10475 READING RD
Practice Address - Street 2:SUITE 115
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45241-2563
Practice Address - Country:US
Practice Address - Phone:513-259-2488
Practice Address - Fax:513-259-2487
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-23
Last Update Date:2008-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty