Provider Demographics
NPI:1477657401
Name:PROFESSIONAL ANESTHESIA ASSOCIATES OF VENICE
Entity Type:Organization
Organization Name:PROFESSIONAL ANESTHESIA ASSOCIATES OF VENICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:DAN
Authorized Official - Middle Name:
Authorized Official - Last Name:KIRKPATRICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:941-365-1172
Mailing Address - Street 1:PO BOX 22845
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33622-2845
Mailing Address - Country:US
Mailing Address - Phone:800-645-4049
Mailing Address - Fax:913-696-7141
Practice Address - Street 1:600 NOKOMIS AVE S
Practice Address - Street 2:STE 200
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34285-3209
Practice Address - Country:US
Practice Address - Phone:941-485-0295
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-11
Last Update Date:2019-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL00957Medicare ID - Type Unspecified