Provider Demographics
NPI:1215118658
Name:MAHONING ANESTHESIA CONSULTANTS, LLC
Entity type:Organization
Organization Name:MAHONING ANESTHESIA CONSULTANTS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:ERNST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-758-2748
Mailing Address - Street 1:PO BOX 33
Mailing Address - Street 2:
Mailing Address - City:LOWELLVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44436-0033
Mailing Address - Country:US
Mailing Address - Phone:330-758-2748
Mailing Address - Fax:330-758-3282
Practice Address - Street 1:7067 TIFFANY BLVD
Practice Address - Street 2:SUITE 230
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44514-1993
Practice Address - Country:US
Practice Address - Phone:330-758-2748
Practice Address - Fax:330-758-3282
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-14
Last Update Date:2007-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34-006401207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0306574Medicaid
OHG36697Medicare UPIN
OH0306574Medicaid