Provider Demographics
NPI:1366431132
Name:GRANT ANESTHESIA SERVICES LTD
Entity type:Organization
Organization Name:GRANT ANESTHESIA SERVICES LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REV CYCLE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:WUESTEWALD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-566-5107
Mailing Address - Street 1:5350 FRANTZ RD
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43016-4259
Mailing Address - Country:US
Mailing Address - Phone:614-544-6355
Mailing Address - Fax:614-544-6350
Practice Address - Street 1:111 S GRANT AVE
Practice Address - Street 2:3RD FL
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43215-4701
Practice Address - Country:US
Practice Address - Phone:614-566-8808
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-14
Last Update Date:2009-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2503644Medicaid
OH2503704Medicaid
OH2503759Medicaid
OH2503919Medicaid
OH2503644Medicaid