1588739031 NPI number — LARGO ANESTHESIA ASSOCIATES

Table of content: (NPI 1588739031)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588739031 NPI number — LARGO ANESTHESIA ASSOCIATES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LARGO ANESTHESIA ASSOCIATES
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:
1588739031
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 869
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LARGO
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33779-0869
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
727-446-5150
Provider Business Mailing Address Fax Number:
727-446-6889

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2025 INDIAN ROCKS RD S
Provider Second Line Business Practice Location Address:
ANESTHESIA DEPARTMENT
Provider Business Practice Location Address City Name:
LARGO
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33774-1035
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
727-446-5150
Provider Business Practice Location Address Fax Number:
727-446-6889
Provider Enumeration Date:
11/21/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BALBIN
Authorized Official First Name:
CATHY
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF ANESTHESIOLOGIST
Authorized Official Telephone Number:
727-446-5150

Provider Taxonomy Codes

  • Taxonomy code: 207L00000X , with the licence number:  207L00000X , 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: 72278 . This is a "GROUP PIN NUMBER" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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