Provider Demographics
NPI:1306917398
Name:GROVES ANSELM ANESTHESIA SERVICES INC
Entity type:Organization
Organization Name:GROVES ANSELM ANESTHESIA SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:GROVES ANSELM
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:330-665-0758
Mailing Address - Street 1:PO BOX 335
Mailing Address - Street 2:
Mailing Address - City:BATH
Mailing Address - State:OH
Mailing Address - Zip Code:44210
Mailing Address - Country:US
Mailing Address - Phone:330-472-5249
Mailing Address - Fax:
Practice Address - Street 1:970 EAST WASHINGTON AVE
Practice Address - Street 2:SUITE 203 MEDINA SURGICAL HOSPITAL
Practice Address - City:MEDINA
Practice Address - State:OH
Practice Address - Zip Code:44256
Practice Address - Country:US
Practice Address - Phone:330-723-7246
Practice Address - Fax:330-725-7855
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAANA45193367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AANA45193OtherROBIN LEE GROVES ANSELM
OH1083624886OtherPERSONAL NPI
OHGR8216607Medicaid
OH0107780Medicare ID - Type Unspecified