1619269180 NPI number — ANESTHESIA INC

Table of content: (NPI 1619269180)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619269180 NPI number — ANESTHESIA INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ANESTHESIA INC
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:
EMERALD COAST PAIN SERVICES
Provider Other Organization Name Type Code:
3
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:
1619269180
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/10/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3997 COMMONS DR W
Provider Second Line Business Mailing Address:
SUITE M
Provider Business Mailing Address City Name:
DESTIN
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32541-8443
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
850-424-3769
Provider Business Mailing Address Fax Number:
850-460-2491

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3997 COMMONS DR W
Provider Second Line Business Practice Location Address:
SUITE M
Provider Business Practice Location Address City Name:
DESTIN
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32541-8443
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
850-424-3769
Provider Business Practice Location Address Fax Number:
850-460-2491
Provider Enumeration Date:
05/03/2011

Additional Information

Authorized Official

Authorized Official Last Name:
KING
Authorized Official First Name:
ANGELA
Authorized Official Middle Name:
MARIE
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
850-424-3769

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  ME0068957 , 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)





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