1104879816 NPI number — NORTH PINELLAS ANESTHESIA ASSOCIATES, PA

Table of content: (NPI 1104879816)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104879816 NPI number — NORTH PINELLAS ANESTHESIA ASSOCIATES, PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORTH PINELLAS ANESTHESIA ASSOCIATES, 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:
1104879816
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/04/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 744436
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:
30374-4436
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:
14547 BRUCE B DOWNS BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TAMPA
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33613-2709
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
800-437-2672
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/17/2006

Additional Information

Authorized Official

Authorized Official Last Name:
VAUGHN
Authorized Official First Name:
KAREN
Authorized Official Middle Name:
MARIE
Authorized Official Title or Position:
OFFICER
Authorized Official Telephone Number:
973-251-1132

Provider Taxonomy Codes

  • Taxonomy code: 207LP2900X , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 367500000X , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207L00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 054522800 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 77913 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: CI8580 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 054522800 . 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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