Provider Demographics
NPI:1558394940
Name:POLK COUNTY ANESTHESIA
Entity Type:Organization
Organization Name:POLK COUNTY ANESTHESIA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANNMARIE
Authorized Official - Middle Name:E
Authorized Official - Last Name:WEEKES
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:863-648-0377
Mailing Address - Street 1:912 HAMILTON PLACE DR
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33813-2667
Mailing Address - Country:US
Mailing Address - Phone:863-648-0377
Mailing Address - Fax:863-648-0377
Practice Address - Street 1:2200 OSPREY BLVD
Practice Address - Street 2:
Practice Address - City:BARTOW
Practice Address - State:FL
Practice Address - Zip Code:33830-3308
Practice Address - Country:US
Practice Address - Phone:863-519-1416
Practice Address - Fax:863-519-1427
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS6136207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL40255OtherBCBS
FL40255Medicare ID - Type Unspecified
E96520Medicare UPIN