Provider Demographics
NPI:1184767436
Name:SED 8 INC.
Entity type:Organization
Organization Name:SED 8 INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AGENT
Authorized Official - Prefix:MS
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:PERTL
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:330-493-8399
Mailing Address - Street 1:1017 FIELD ST NW
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44709-1635
Mailing Address - Country:US
Mailing Address - Phone:330-493-8399
Mailing Address - Fax:216-928-0141
Practice Address - Street 1:1017 FIELD ST NW
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44709-1635
Practice Address - Country:US
Practice Address - Phone:330-493-8399
Practice Address - Fax:216-674-5231
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-15
Last Update Date:2010-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH048040367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2284086Medicaid
OH272687622-00OtherBWC#
OH2284086Medicaid