1467949776 NPI number — FLORIDA ANESTHESIA MEDICAL SERVICES 1, PA

Table of content: (NPI 1467949776)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467949776 NPI number — FLORIDA ANESTHESIA MEDICAL SERVICES 1, PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FLORIDA ANESTHESIA MEDICAL SERVICES 1, 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:
1467949776
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/20/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
265 BROOKVIEW CENTRE WAY STE 400
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KNOXVILLE
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37919-4052
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
865-693-1000
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4016 STATE ROAD 674
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SUN CITY CENTER
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33573-5256
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
813-634-3301
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/23/2018

Additional Information

Authorized Official

Authorized Official Last Name:
KIRKLAND
Authorized Official First Name:
HOLLIE
Authorized Official Middle Name:
Authorized Official Title or Position:
PROVIDER ENROLLMENT
Authorized Official Telephone Number:
865-985-7062

Provider Taxonomy Codes

  • Taxonomy code: 207L00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207LP2900X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





Copyright © 2007-2024 www.npivalidator.com