Organization
MALABAR ANESTHESIA SERVICES LTD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DAVID M GRAHAM CRNA (PRESIDENT)
(419) 566-4152
Entity
Organization
Contact information
Practice address
3300 WELTY RD, LUCAS, OH 44843-9729
(419) 566-4152
(419) 842-3875
Mailing address
PO BOX 182255, COLUMBUS, OH 43218-2255
(614) 430-5764
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2298606
—
OH
01
—
CB6800
MEDICARE RAILROAD
—
Enumeration date
05/11/2006
Last updated
04/20/2008
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