Organization
OHIO SURGICAL ANESTHESIA LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ANDREW RIBAUDO (PRESIDENT)
(404) 217-2659
Entity
Organization
Contact information
Practice address
5319 HOAG DR, ROOM 1, SHEFFIELD VILLAGE, OH 44035-1494
(855) 600-5161
(706) 650-1034
Mailing address
PO BOX 310407, DES MOINES, IA 50331-0407
(800) 394-4445
(706) 650-1034
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
—
—
207LP2900X
Pain Medicine (Anesthesiology) Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
9382561
MEDICARE PTAN
OH
Enumeration date
05/06/2009
Last updated
10/31/2016
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