Provider Demographics
NPI:1972596856
Name:SERVICK, CHESTER (CRNA)
Entity type:Individual
Prefix:
First Name:CHESTER
Middle Name:
Last Name:SERVICK
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 1:567 BRADFORD CT
Mailing Address - Street 2:
Mailing Address - City:ELMORE
Mailing Address - State:OH
Mailing Address - Zip Code:43416-9553
Mailing Address - Country:US
Mailing Address - Phone:419-862-0044
Mailing Address - Fax:
Practice Address - Street 1:2801 BAY PARK DR
Practice Address - Street 2:DEPARTMENT OF SURGERY
Practice Address - City:OREGON
Practice Address - State:OH
Practice Address - Zip Code:43616-4920
Practice Address - Country:US
Practice Address - Phone:419-690-7652
Practice Address - Fax:419-697-7726
Is Sole Proprietor?:No
Enumeration Date:2005-08-26
Last Update Date:2007-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN277026367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5182111Medicaid
OH000000479840OtherANTHEM
OH04097AOtherPARAMOUNT
MI4486239Medicaid
OH341881145-003OtherMMO
OHP00378258OtherRRMC
OH2333522Medicaid
MI5182111OtherMICHIGAN MEDICAID
OH000000246991OtherANTHEM
OH2333522Medicaid
MI5182111Medicaid
OH341881145-003OtherMMO