1932205606 NPI number — COASTAL ANESTHESIA, P A

Table of content: (NPI 1932205606)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1932205606 NPI number — COASTAL ANESTHESIA, P A

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COASTAL ANESTHESIA, P A
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:
1932205606
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 10583
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BIRMINGHAM
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35202-0583
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
352-867-8898
Provider Business Mailing Address Fax Number:
352-732-6282

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1001 COLLEGE BLVD W STE H
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:
32578-1049
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
850-279-4417
Provider Business Practice Location Address Fax Number:
850-279-4212
Provider Enumeration Date:
09/16/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
EDERER
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
Authorized Official Title or Position:
DO/PRESIDENT
Authorized Official Telephone Number:
352-867-8898

Provider Taxonomy Codes

  • Taxonomy code: 207LP2900X , 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: DE0932 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 98947 . This is a "BCBS FL" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".