Provider Demographics
NPI:1285619122
Name:SARBAUGH, KEITH ALAN (CRNA)
Entity type:Individual
Prefix:
First Name:KEITH
Middle Name:ALAN
Last Name:SARBAUGH
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:945 BETHESDA DR.
Mailing Address - Street 2:SUITE 200B
Mailing Address - City:ZANESVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43701
Mailing Address - Country:US
Mailing Address - Phone:740-455-4937
Mailing Address - Fax:740-455-4931
Practice Address - Street 1:2951 MAPLE AVE.
Practice Address - Street 2:
Practice Address - City:ZANESVILLE
Practice Address - State:OH
Practice Address - Zip Code:43701
Practice Address - Country:US
Practice Address - Phone:513-672-3309
Practice Address - Fax:513-672-3323
Is Sole Proprietor?:No
Enumeration Date:2005-12-14
Last Update Date:2010-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH123786367500000X
OHCOA.00495-NA367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0690186Medicaid
430046112OtherRAILROAD MEDICARE
OH0690186Medicaid