Provider Demographics
NPI:1235329814
Name:ANESTHESIA ASSOCIATES OF VERO BEACH PA
Entity Type:Organization
Organization Name:ANESTHESIA ASSOCIATES OF VERO BEACH PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:W
Authorized Official - Last Name:AGNEW
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:772-794-4236
Mailing Address - Street 1:1355 37TH ST
Mailing Address - Street 2:SUITE 304
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32960-7321
Mailing Address - Country:US
Mailing Address - Phone:772-794-4236
Mailing Address - Fax:772-794-4621
Practice Address - Street 1:1355 37TH ST
Practice Address - Street 2:SUITE 304
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960-7321
Practice Address - Country:US
Practice Address - Phone:772-794-4236
Practice Address - Fax:772-794-4621
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-30
Last Update Date:2008-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME89357207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAG586OtherMEDICARE PTAN
FL16367OtherBLUE CROSS BLUE SHIELD FL