Provider Demographics
NPI:1497199731
Name:TWIN CITIES ANESTHESIA ASSOCIATES, PL
Entity Type:Organization
Organization Name:TWIN CITIES ANESTHESIA ASSOCIATES, PL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ARTHUR
Authorized Official - Middle Name:P
Authorized Official - Last Name:BROADERICK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:850-803-2297
Mailing Address - Street 1:PO BOX 7419
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32891-7419
Mailing Address - Country:US
Mailing Address - Phone:866-619-4860
Mailing Address - Fax:866-665-2702
Practice Address - Street 1:2190 HIGHWAY 85 N
Practice Address - Street 2:
Practice Address - City:NICEVILLE
Practice Address - State:FL
Practice Address - Zip Code:32578-1045
Practice Address - Country:US
Practice Address - Phone:850-678-4131
Practice Address - Fax:850-729-9342
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-17
Last Update Date:2013-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME69348207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty