Provider Demographics
NPI:1326218439
Name:AMELIA ISLAND ANESTHESIA LLC
Entity Type:Organization
Organization Name:AMELIA ISLAND ANESTHESIA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LESTER
Authorized Official - Middle Name:N
Authorized Official - Last Name:HAUGE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:941-752-1900
Mailing Address - Street 1:1790 GARDENIA ST
Mailing Address - Street 2:
Mailing Address - City:FERNANDINA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32034-1980
Mailing Address - Country:US
Mailing Address - Phone:941-752-1900
Mailing Address - Fax:941-752-1905
Practice Address - Street 1:2416 LYNNDALE RD
Practice Address - Street 2:SUITE 110
Practice Address - City:FERNANDINA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32034-5252
Practice Address - Country:US
Practice Address - Phone:941-752-1900
Practice Address - Fax:941-752-1905
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-04
Last Update Date:2008-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME78635207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty