Basic Information
| Provider Information | |||||||||
| NPI: | 1174914352 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CGI ANESTHESIA ASSOCIATES LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5127 HIGHWAY 17 SOUTH | ||||||||
| Address2: | |||||||||
| City: | MURRELLS INLET | ||||||||
| State: | SC | ||||||||
| PostalCode: | 295765045 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8436512624 | ||||||||
| FaxNumber: | 8434914023 | ||||||||
| Practice Location | |||||||||
| Address1: | 4746 MONTGOMERY RD | ||||||||
| Address2: | SUITE 202 | ||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452122622 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5134516001 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/10/2015 | ||||||||
| LastUpdateDate: | 03/12/2015 | ||||||||
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| AuthorizedOfficialLastName: | HESS | ||||||||
| AuthorizedOfficialFirstName: | DAVID | ||||||||
| AuthorizedOfficialMiddleName: | D | ||||||||
| AuthorizedOfficialTitleorPosition: | MANAGING MEMBER | ||||||||
| AuthorizedOfficialTelephone: | 5134516001 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | OH | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology | 367500000X | Y | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
No ID Information.