Provider Demographics
NPI:1316202104
Name:MID-FLORIDA ANESTHESIA ASSOCIATES, INC.
Entity Type:Organization
Organization Name:MID-FLORIDA ANESTHESIA ASSOCIATES, INC.
Other - Org Name:RESOLUTE PAIN SOLUTIONS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JAY
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-465-2598
Mailing Address - Street 1:7100 W CAMINO REAL
Mailing Address - Street 2:SUITE 301
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33433-5510
Mailing Address - Country:US
Mailing Address - Phone:561-465-2598
Mailing Address - Fax:561-465-2599
Practice Address - Street 1:10244 S US HIGHWAY 1
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34952-5615
Practice Address - Country:US
Practice Address - Phone:772-337-7676
Practice Address - Fax:772-337-9034
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RESOLUTE ANESTHESIA AND PAIN SOLUTIONS, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-07-09
Last Update Date:2015-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL6167750003Medicare NSC
FL33576BMedicare PIN