Organization
MALABAR ANESTHESIA SERVICES INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN R JOHNSON CRNA (OWNER)
(419) 775-7877
Entity
Organization
Contact information
Practice address
335 GLESSNER AVE, MANSFIELD, OH 44903-2269
(419) 775-7877
Mailing address
PO BOX 182255, COLUMBUS, OH 43218-2255
(419) 775-7877
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0117130
—
OH
01
—
H323850
MEDICARE PTAN
OH
Enumeration date
01/14/2015
Last updated
08/19/2015
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