1306187513 NPI number — AMSURG ALTAMONTE SPRINGS ANESTHESIA, 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 1306187513 NPI number — AMSURG ALTAMONTE SPRINGS ANESTHESIA, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AMSURG ALTAMONTE SPRINGS ANESTHESIA, 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:
1306187513
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/25/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1A BURTON HILLS BLVD STE 300
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NASHVILLE
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37215-6153
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
615-240-3820
Provider Business Mailing Address Fax Number:
615-234-1720

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
623 MAITLAND AVE
Provider Second Line Business Practice Location Address:
SUITE 1100
Provider Business Practice Location Address City Name:
ALTAMONTE SPRINGS
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32701-6823
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
407-478-0871
Provider Business Practice Location Address Fax Number:
615-234-1809
Provider Enumeration Date:
03/13/2013

Additional Information

Authorized Official

Authorized Official Last Name:
KOCHENDORFER
Authorized Official First Name:
JEAN
Authorized Official Middle Name:
Authorized Official Title or Position:
SR DIRECTOR OF RCM TRANSFORMATION
Authorized Official Telephone Number:
615-240-3795

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: 008917900 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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