Provider Demographics
NPI:1588755656
Name:OHIO CRNA
Entity type:Organization
Organization Name:OHIO CRNA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:TERENCE
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:ROSS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:330-723-7246
Mailing Address - Street 1:970 E WASHINGTON ST
Mailing Address - Street 2:SUITE 203
Mailing Address - City:MEDINA
Mailing Address - State:OH
Mailing Address - Zip Code:44256-3332
Mailing Address - Country:US
Mailing Address - Phone:330-723-7246
Mailing Address - Fax:330-725-7855
Practice Address - Street 1:1000 E WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:MEDINA
Practice Address - State:OH
Practice Address - Zip Code:44256-2170
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:2006-09-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0909959Medicaid
OH0909959Medicaid