Provider Demographics
NPI:1083953772
Name:AMSURG ROCKLEDGE FL ANESTHESIA LLC
Entity Type:Organization
Organization Name:AMSURG ROCKLEDGE FL ANESTHESIA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SR DIRECTOR OF RCM TRANSFORMATION
Authorized Official - Prefix:
Authorized Official - First Name:JEAN
Authorized Official - Middle Name:
Authorized Official - Last Name:KOCHENDOFER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-240-3795
Mailing Address - Street 1:1A BURTON HILLS BLVD
Mailing Address - Street 2:ATTN: PROVIDER ENROLLMENT
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37215-6187
Mailing Address - Country:US
Mailing Address - Phone:615-240-3809
Mailing Address - Fax:615-234-1809
Practice Address - Street 1:1974 ROCKLEDGE BLVD
Practice Address - Street 2:SUITE 102
Practice Address - City:ROCKLEDGE
Practice Address - State:FL
Practice Address - Zip Code:32955-3756
Practice Address - Country:US
Practice Address - Phone:321-504-4440
Practice Address - Fax:321-504-4470
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-31
Last Update Date:2023-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLS620503859240OtherDRIVER LICENSE