1578681664 NPI number — ANESTHESIA CONSULTANTS OF CENTRAL FLORIDA,LLC

Table of content: (NPI 1578681664)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578681664 NPI number — ANESTHESIA CONSULTANTS OF CENTRAL FLORIDA,LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ANESTHESIA CONSULTANTS OF CENTRAL 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:
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:
1578681664
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/01/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 22201
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TAMPA
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33622-2201
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
863-651-1831
Provider Business Mailing Address Fax Number:
844-876-0873

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2400 DUNDEE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WINTER HAVEN
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33884-1166
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
352-867-8898
Provider Business Practice Location Address Fax Number:
352-732-6282
Provider Enumeration Date:
03/27/2007

Additional Information

Authorized Official

Authorized Official Last Name:
VILLARREAL
Authorized Official First Name:
JORGE
Authorized Official Middle Name:
Authorized Official Title or Position:
MD
Authorized Official Telephone Number:
863-651-1831

Provider Taxonomy Codes

  • Taxonomy code: 207LP2900X , 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)

  • Identifier: 97589 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 307335100 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 115260400 . 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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