Provider Demographics
NPI:1992758023
Name:NORTHEAST OHIO ANESTHESIA, LLC.
Entity type:Organization
Organization Name:NORTHEAST OHIO ANESTHESIA, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:V
Authorized Official - Last Name:BARRETT
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:330-602-0767
Mailing Address - Street 1:659 BOULEVARD ST
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:OH
Mailing Address - Zip Code:44622-2026
Mailing Address - Country:US
Mailing Address - Phone:330-602-0767
Mailing Address - Fax:330-365-3831
Practice Address - Street 1:3755 ORANGE PL
Practice Address - Street 2:
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122-4426
Practice Address - Country:US
Practice Address - Phone:330-602-0767
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-18
Last Update Date:2011-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2306338Medicaid
OHNO9320741Medicare PIN