1801801527 NPI number — C R ANESTHESIA PA

Table of content: (NPI 1801801527)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801801527 NPI number — C R ANESTHESIA PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
C R ANESTHESIA PA
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:
1801801527
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/02/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 742318
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ATLANTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30374-2103
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
855-250-6016
Provider Business Mailing Address Fax Number:
855-206-8399

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6201 N SUNCOAST BLVD
Provider Second Line Business Practice Location Address:
C/O SEVEN RIVERS REGIONAL
Provider Business Practice Location Address City Name:
CRYSTAL RIVER
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34428
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
317-614-9863
Provider Business Practice Location Address Fax Number:
844-876-0873
Provider Enumeration Date:
07/30/2006

Additional Information

Authorized Official

Authorized Official Last Name:
CALODNEY
Authorized Official First Name:
LEONARD
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
352-795-4008

Provider Taxonomy Codes

  • Taxonomy code: 207L00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 374292000 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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