Provider Demographics
NPI:1427165570
Name:MERCY ANESTHESIOLOGISTS INC
Entity type:Organization
Organization Name:MERCY ANESTHESIOLOGISTS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:THALES
Authorized Official - Middle Name:
Authorized Official - Last Name:PAVLATOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-399-7164
Mailing Address - Street 1:2790 KILKENNY DR
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45503-1181
Mailing Address - Country:US
Mailing Address - Phone:937-399-7164
Mailing Address - Fax:937-717-5370
Practice Address - Street 1:100 W MAIN ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OH
Practice Address - Zip Code:45502-1312
Practice Address - Country:US
Practice Address - Phone:937-521-3900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-24
Last Update Date:2013-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0201347Medicaid
OH9918401Medicare ID - Type Unspecified
OH0201347Medicaid