1245443829 NPI number — FT. WALTON BEACH ANESTHESIA SERVICES LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245443829 NPI number — FT. WALTON BEACH ANESTHESIA SERVICES LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FT. WALTON BEACH ANESTHESIA SERVICES LLC
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:
1245443829
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/28/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1000 MARWALT DRIVE
Provider Second Line Business Mailing Address:
ATTN ALLEN KERSHER
Provider Business Mailing Address City Name:
FT. WALTON BEAC
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32547-6039
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
850-375-2395
Provider Business Mailing Address Fax Number:
866-417-1940

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1000 MARWALT DRIVE
Provider Second Line Business Practice Location Address:
ATTN ALLEN KERCHER
Provider Business Practice Location Address City Name:
FT. WALTON BEACH
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32547-6039
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
850-375-2395
Provider Business Practice Location Address Fax Number:
866-471-1940
Provider Enumeration Date:
05/08/2007

Additional Information

Authorized Official

Authorized Official Last Name:
KERCHER
Authorized Official First Name:
ALLEN
Authorized Official Middle Name:
W
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
850-474-8155

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)





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