Provider Demographics
NPI:1023201662
Name:MID FLORIDA ANESTHESIA ASSOCIATES, INC
Entity Type:Organization
Organization Name:MID FLORIDA ANESTHESIA ASSOCIATES, INC
Other - Org Name:COASTAL PAIN SOLUTIONS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARC
Authorized Official - Middle Name:I
Authorized Official - Last Name:LEVINE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:772-337-7676
Mailing Address - Street 1:75 REMITTANCE DR
Mailing Address - Street 2:SUITE 6633
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60675-6633
Mailing Address - Country:US
Mailing Address - Phone:772-337-7676
Mailing Address - Fax:772-337-9034
Practice Address - Street 1:2100 SE OCEAN BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34996-3332
Practice Address - Country:US
Practice Address - Phone:772-223-2115
Practice Address - Fax:772-337-9034
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-27
Last Update Date:2012-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLCH1211OtherRAILROAD MEDICARE
FL33576OtherBCBS OF FLORIDA
FL377780400Medicaid
FL33576OtherBCBS OF FLORIDA