Provider Demographics
NPI:1033120324
Name:CENTER ANESTHESIA, INC
Entity Type:Organization
Organization Name:CENTER ANESTHESIA, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PATIENT ACCOUNTING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:YATES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-423-9994
Mailing Address - Street 1:PO BOX 60074
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33906-6074
Mailing Address - Country:US
Mailing Address - Phone:850-423-9994
Mailing Address - Fax:850-423-9962
Practice Address - Street 1:63 BARKLEY CIR
Practice Address - Street 2:SUITE 104
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33907-4514
Practice Address - Country:US
Practice Address - Phone:850-423-9994
Practice Address - Fax:850-423-9962
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-11
Last Update Date:2008-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL304894200Medicaid
FLK1733Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER