Provider Demographics
NPI:1033136064
Name:BROAD ANESTHESIA ASSOCIATES
Entity Type:Organization
Organization Name:BROAD ANESTHESIA ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:
Authorized Official - Last Name:ASTROVE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-362-4400
Mailing Address - Street 1:DEPT 991 PO BOX 850001
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32885-0991
Mailing Address - Country:US
Mailing Address - Phone:908-653-9399
Mailing Address - Fax:
Practice Address - Street 1:501 GLADES RD
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33432-1419
Practice Address - Country:US
Practice Address - Phone:561-362-4400
Practice Address - Fax:561-362-4445
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-16
Last Update Date:2013-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL266644800Medicaid
FL99978OtherBCBS
FL99978Medicare PIN