1275838625 NPI number — COMMONWEALTH ANESTHESIA GROUP LLC

Table of content: (NPI 1275838625)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275838625 NPI number — COMMONWEALTH ANESTHESIA GROUP LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COMMONWEALTH ANESTHESIA GROUP 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:
1275838625
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/06/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6094 14TH ST W
Provider Second Line Business Mailing Address:
STE 168
Provider Business Mailing Address City Name:
BRADENTON
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34207-4104
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
941-360-1566
Provider Business Mailing Address Fax Number:
941-358-9818

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3914 CENTREVILLE RD
Provider Second Line Business Practice Location Address:
STE 350
Provider Business Practice Location Address City Name:
CHANTILLY
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
20151-3289
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
941-360-1566
Provider Business Practice Location Address Fax Number:
941-358-9818
Provider Enumeration Date:
01/17/2011

Additional Information

Authorized Official

Authorized Official Last Name:
LASNER
Authorized Official First Name:
LANCE
Authorized Official Middle Name:
Authorized Official Title or Position:
MEMBER
Authorized Official Telephone Number:
941-360-1566

Provider Taxonomy Codes

  • Taxonomy code: 367500000X ; 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)





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