Provider Demographics
NPI:1083665426
Name:FLORIDA GULF-TO-BAY ANESTHESIOLOGY ASSOCIATES, LLC
Entity Type:Organization
Organization Name:FLORIDA GULF-TO-BAY ANESTHESIOLOGY ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DEVANAND
Authorized Official - Middle Name:
Authorized Official - Last Name:MANGAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:813-844-4396
Mailing Address - Street 1:809 S ALBANY AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33606-2407
Mailing Address - Country:US
Mailing Address - Phone:813-844-4396
Mailing Address - Fax:813-844-4972
Practice Address - Street 1:300 CIRCLE FRONT DR
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47715-7196
Practice Address - Country:US
Practice Address - Phone:813-844-4396
Practice Address - Fax:813-844-4972
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-12
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL207L00000X, 207LC0200X, 207LP2900X
IN207L00000X, 207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty
No207LC0200XAllopathic & Osteopathic PhysiciansAnesthesiologyCritical Care MedicineGroup - Multi-Specialty
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL45642OtherBCBS GROUP NUMBER
INDD7966OtherRR MEDICARE
FL262127400Medicaid
IN200808150AMedicaid
IN200808150AMedicaid
FL262127400Medicaid