Provider Demographics
NPI:1497737654
Name:PEACE RIVER ANESTHESIOLOGY ASSOCIATES PA
Entity Type:Organization
Organization Name:PEACE RIVER ANESTHESIOLOGY ASSOCIATES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:
Authorized Official - Last Name:POLLIZZI
Authorized Official - Suffix:
Authorized Official - Credentials:M D
Authorized Official - Phone:941-625-1951
Mailing Address - Street 1:PO BOX 510626
Mailing Address - Street 2:
Mailing Address - City:PUNTA GORDA
Mailing Address - State:FL
Mailing Address - Zip Code:33951-0626
Mailing Address - Country:US
Mailing Address - Phone:941-625-1951
Mailing Address - Fax:941-625-3675
Practice Address - Street 1:809 E MARION AVE
Practice Address - Street 2:CHARLOTTE REGIONAL MEDICAL CENTER
Practice Address - City:PUNTA GORDA
Practice Address - State:FL
Practice Address - Zip Code:33950-3819
Practice Address - Country:US
Practice Address - Phone:941-637-2580
Practice Address - Fax:641-637-2571
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL72852OtherFL BLUE SHIELD GROUP PROV
FL72852BMedicare ID - Type UnspecifiedGROUP PROVIDER NUMBER
FL72852Medicare ID - Type UnspecifiedGROUP PROVIDER NUMBER