Provider Demographics
NPI:1467774711
Name:PALM COAST ANESTHESIA
Entity Type:Organization
Organization Name:PALM COAST ANESTHESIA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:MRS
Authorized Official - First Name:STACEY
Authorized Official - Middle Name:
Authorized Official - Last Name:CASTROVINCI
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:954-941-3369
Mailing Address - Street 1:150 SW 12TH AVE
Mailing Address - Street 2:SUITE 450
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33069
Mailing Address - Country:US
Mailing Address - Phone:954-941-3369
Mailing Address - Fax:954-941-8470
Practice Address - Street 1:150 SW 12TH AVE
Practice Address - Street 2:SUITE 450
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33069
Practice Address - Country:US
Practice Address - Phone:954-941-3369
Practice Address - Fax:954-941-8470
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-26
Last Update Date:2016-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty