Provider Demographics
NPI:1508884446
Name:AMBULATORY ANESTHESIA PROVIDERS,LLC
Entity Type:Organization
Organization Name:AMBULATORY ANESTHESIA PROVIDERS,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MGR
Authorized Official - Prefix:
Authorized Official - First Name:RITA
Authorized Official - Middle Name:
Authorized Official - Last Name:BERON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:386-274-1744
Mailing Address - Street 1:1890 LPGA BLVD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32117-7130
Mailing Address - Country:US
Mailing Address - Phone:386-274-1744
Mailing Address - Fax:386-274-1644
Practice Address - Street 1:1890 LPGA BLVD
Practice Address - Street 2:SUITE 210
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32117-7130
Practice Address - Country:US
Practice Address - Phone:386-274-1744
Practice Address - Fax:386-274-1644
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-18
Last Update Date:2010-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL34793Medicare UPIN