1538550975 NPI number — BAY AREA CONSORTIUM OF ANESTHESIA SERVICES OF FLORIDA, LLC

Table of content: (NPI 1538550975)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538550975 NPI number — BAY AREA CONSORTIUM OF ANESTHESIA SERVICES OF FLORIDA, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BAY AREA CONSORTIUM OF ANESTHESIA SERVICES OF FLORIDA, 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:
BACAS OF FLORIDA
Provider Other Organization Name Type Code:
3
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:
1538550975
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/27/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1302 WAUGH DR
Provider Second Line Business Mailing Address:
PMB 533
Provider Business Mailing Address City Name:
HOUSTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77019-3908
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
844-342-2227
Provider Business Mailing Address Fax Number:
713-401-9758

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3111 45TH ST
Provider Second Line Business Practice Location Address:
SUITE 5
Provider Business Practice Location Address City Name:
WEST PALM BEACH
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33407-1974
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
844-342-2227
Provider Business Practice Location Address Fax Number:
713-401-9758
Provider Enumeration Date:
02/06/2015

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
BOND
Authorized Official First Name:
NELSON
Authorized Official Middle Name:
K
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
404-502-1155

Provider Taxonomy Codes

  • Taxonomy code: 207LP2900X , with the licence number:  ME111629 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208VP0014X , with the licence number: ME111629 , 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)