Provider Demographics
NPI:1255494803
Name:WEST COAST ANESTHESIOLOGY ASSOCIATES
Entity Type:Organization
Organization Name:WEST COAST ANESTHESIOLOGY ASSOCIATES
Other - Org Name:PAIN MEDICINE GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARLO
Authorized Official - Middle Name:A
Authorized Official - Last Name:REYES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:941-365-5672
Mailing Address - Street 1:2621 CATTLEMEN RD STE 202
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34232-6212
Mailing Address - Country:US
Mailing Address - Phone:941-365-5672
Mailing Address - Fax:941-365-5854
Practice Address - Street 1:2621 CATTLEMEN RD STE 202
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34232-6212
Practice Address - Country:US
Practice Address - Phone:941-365-5672
Practice Address - Fax:941-365-5854
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-18
Last Update Date:2022-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME37642207LP2900X
207LP2900X, 208VP0000X, 208VP0014X, 367500000X
FLME1165032081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Multi-Specialty
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Multi-Specialty
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty
No367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SLB7MOtherBCBS
FL77548Medicare ID - Type UnspecifiedGROUP MC NUMBER