Basic Information
| Provider Information | |||||||||
| NPI: | 1376536490 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | QUEEN CITY ANESTHESIOLOGISTS INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 200 NORTHLAND BLVD | ||||||||
| Address2: | |||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452463604 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5136723300 | ||||||||
| FaxNumber: | 5136723323 | ||||||||
| Practice Location | |||||||||
| Address1: | 2446 KIPLING AVE | ||||||||
| Address2: | |||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452396650 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5136723300 | ||||||||
| FaxNumber: | 5136723323 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/24/2005 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| AuthorizedOfficialLastName: | BECKMEYER | ||||||||
| AuthorizedOfficialFirstName: | WILLIAM | ||||||||
| AuthorizedOfficialMiddleName: | P | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 5136724111 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | OH | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | 2056546 | 05 | OH | MEDICAID |