Provider Demographics
NPI:1285679894
Name:LAKE COUNTY ANESTHESIA ASSOCIATES PLLC
Entity Type:Organization
Organization Name:LAKE COUNTY ANESTHESIA ASSOCIATES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:VINCENT
Authorized Official - Middle Name:C
Authorized Official - Last Name:PALMIRE
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:352-867-8311
Mailing Address - Street 1:PO BOX 3130
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34478-3130
Mailing Address - Country:US
Mailing Address - Phone:352-867-0516
Mailing Address - Fax:352-867-5076
Practice Address - Street 1:1511 SW 1ST AVE
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-6505
Practice Address - Country:US
Practice Address - Phone:352-867-0516
Practice Address - Fax:352-867-5076
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-18
Last Update Date:2007-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL74504OtherBCBS FL
FL74504Medicare PIN
FL74504OtherBCBS FL