1497199731 NPI number — TWIN CITIES ANESTHESIA ASSOCIATES, PL

Table of content: (NPI 1497199731)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497199731 NPI number — TWIN CITIES ANESTHESIA ASSOCIATES, PL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TWIN CITIES ANESTHESIA ASSOCIATES, PL
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1497199731
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/18/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 7419
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ORLANDO
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32891-7419
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
866-619-4860
Provider Business Mailing Address Fax Number:
866-665-2702

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2190 HIGHWAY 85 N
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NICEVILLE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32578-1045
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
850-678-4131
Provider Business Practice Location Address Fax Number:
850-729-9342
Provider Enumeration Date:
04/17/2013

Additional Information

Authorized Official

Authorized Official Last Name:
BROADERICK
Authorized Official First Name:
ARTHUR
Authorized Official Middle Name:
P
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
850-803-2297

Provider Taxonomy Codes

  • Taxonomy code: 207L00000X , with the licence number:  ME69348 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 008830600 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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