Provider Demographics
NPI:1033171905
Name:WEST COAST ANESTHESIA PA
Entity Type:Organization
Organization Name:WEST COAST ANESTHESIA PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:FERNANDO
Authorized Official - Middle Name:
Authorized Official - Last Name:BUENO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:352-344-8080
Mailing Address - Street 1:3653 E FOREST DR
Mailing Address - Street 2:
Mailing Address - City:INVERNESS
Mailing Address - State:FL
Mailing Address - Zip Code:34453-0787
Mailing Address - Country:US
Mailing Address - Phone:352-344-8080
Mailing Address - Fax:352-344-0631
Practice Address - Street 1:3621 E FOREST DR
Practice Address - Street 2:
Practice Address - City:INVERNESS
Practice Address - State:FL
Practice Address - Zip Code:34453-0787
Practice Address - Country:US
Practice Address - Phone:352-637-2787
Practice Address - Fax:352-637-2525
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL80110256715207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
138804AFOtherPREFCARE
FLAVMED HEALTH PLANOther292827
NY9739978OtherGHI
GADA5725Medicare ID - Type UnspecifiedRAILROAD MEDICARE
FLK5152Medicare ID - Type UnspecifiedFLORIDA MEDICARE