1285679894 NPI number — LAKE COUNTY ANESTHESIA ASSOCIATES PLLC

Table of content: (NPI 1285679894)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285679894 NPI number — LAKE COUNTY ANESTHESIA ASSOCIATES PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LAKE COUNTY ANESTHESIA ASSOCIATES PLLC
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:
1285679894
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/30/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 3130
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OCALA
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34478-3130
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
352-867-0516
Provider Business Mailing Address Fax Number:
352-867-5076

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1511 SW 1ST AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OCALA
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34471-6505
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
352-867-0516
Provider Business Practice Location Address Fax Number:
352-867-5076
Provider Enumeration Date:
06/18/2006

Additional Information

Authorized Official

Authorized Official Last Name:
PALMIRE
Authorized Official First Name:
VINCENT
Authorized Official Middle Name:
C.
Authorized Official Title or Position:
PARTNER
Authorized Official Telephone Number:
352-867-8311

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)

  • Identifier: 74504 . This is a "BCBS FL" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com