Organization
FAYETTE ANESTHESIA SERVICES, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. RICHARD SWENSEN CRNA (PRESIDENT)
(740) 606-0630
Entity
Organization
Contact information
Practice address
1150 W LOCUST ST, SUITE 200, WILMINGTON, OH 45177-2572
(937) 383-0088
(937) 382-4654
Mailing address
PO BOX 153, GERMANTOWN, OH 45327-0153
(717) 263-5562
(717) 263-1566
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2299123
—
OH
Enumeration date
08/17/2005
Last updated
01/12/2017
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