Individual
CHESTER SERVICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
2801 BAY PARK DR, DEPARTMENT OF SURGERY, OREGON, OH 43616-4920
(419) 690-7652
(419) 697-7726
Mailing address
567 BRADFORD CT, ELMORE, OH 43416-9553
(419) 862-0044
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
RN277026
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000246991
ANTHEM
OH
01
—
000000479840
ANTHEM
OH
01
—
04097A
PARAMOUNT
OH
05
—
2333522
—
OH
01
—
341881145-003
MMO
OH
05
—
4486239
—
MI
01
—
5182111
MICHIGAN MEDICAID
MI
05
—
5182111
—
MI
01
—
P00378258
RRMC
OH
Enumeration date
08/26/2005
Last updated
10/24/2007
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