1760420111 NPI number — TRI-COUNTY ANESTHESIA VOLUSIA

Table of content: (NPI 1760420111)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760420111 NPI number — TRI-COUNTY ANESTHESIA VOLUSIA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TRI-COUNTY ANESTHESIA VOLUSIA
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:
ANESTHESIA SOLUTIONS OF CENTRAL FLORIDA
Provider Other Organization Name Type Code:
5
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:
1760420111
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:
291 SOUTHHALL LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MAITLAND
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32751-7290
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
407-667-0444
Provider Business Mailing Address Fax Number:
407-667-4338

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1401 W SEMINOLE BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SANFORD
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32771-6737
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
407-667-0444
Provider Business Practice Location Address Fax Number:
407-667-4338
Provider Enumeration Date:
06/04/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ESPINOLA
Authorized Official First Name:
ARTURO
Authorized Official Middle Name:
FRANCISCO
Authorized Official Title or Position:
PRESIDENT OF ANES. SOLUTIONS
Authorized Official Telephone Number:
407-667-0444

Provider Taxonomy Codes

  • Taxonomy code: 207L00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 367500000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 38150 . This is a "BCBS" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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