Provider Demographics
NPI:1376689208
Name:SURFSIDE ANESTHESIA SERVICES INC
Entity Type:Organization
Organization Name:SURFSIDE ANESTHESIA SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:C.E.O.
Authorized Official - Prefix:
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:FREEMAN
Authorized Official - Last Name:DE MEO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-448-6166
Mailing Address - Street 1:6 ARAGON AVENUE
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33143
Mailing Address - Country:US
Mailing Address - Phone:305-448-6166
Mailing Address - Fax:305-448-6150
Practice Address - Street 1:6 ARAGON AVENUE
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33143-5300
Practice Address - Country:US
Practice Address - Phone:305-448-6166
Practice Address - Fax:305-448-6150
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-29
Last Update Date:2013-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL21344Medicare PIN