Provider Demographics
NPI:1184648792
Name:MELBOURNE ANESTHESIA, P.A.
Entity Type:Organization
Organization Name:MELBOURNE ANESTHESIA, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:H
Authorized Official - Last Name:KATZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:321-729-9493
Mailing Address - Street 1:10830 S TROPICAL TRL
Mailing Address - Street 2:
Mailing Address - City:MERRITT ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32952-7013
Mailing Address - Country:US
Mailing Address - Phone:321-729-9493
Mailing Address - Fax:
Practice Address - Street 1:1340 MEDICAL PARK DR
Practice Address - Street 2:SUITE 101
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901-3246
Practice Address - Country:US
Practice Address - Phone:321-729-9493
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 58208207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE59247Medicare UPIN
FLE3370Medicare ID - Type Unspecified