Provider Demographics
NPI:1275640328
Name:FLORIDA AMBULATORY ANESTHESIA LLC
Entity Type:Organization
Organization Name:FLORIDA AMBULATORY ANESTHESIA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:N
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-422-1950
Mailing Address - Street 1:PO BOX 9117
Mailing Address - Street 2:
Mailing Address - City:UNIONDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11555-9117
Mailing Address - Country:US
Mailing Address - Phone:800-910-9207
Mailing Address - Fax:
Practice Address - Street 1:1395 STATE ROAD 7
Practice Address - Street 2:SUITE 100
Practice Address - City:WELLINGTON
Practice Address - State:FL
Practice Address - Zip Code:33414-9326
Practice Address - Country:US
Practice Address - Phone:561-422-1950
Practice Address - Fax:561-422-0997
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-24
Last Update Date:2010-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL271682800Medicaid
FLK6745Medicare ID - Type Unspecified