Provider Demographics
NPI:1568853927
Name:INTERVENTIONAL ANESTHESIA LLC
Entity Type:Organization
Organization Name:INTERVENTIONAL ANESTHESIA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:MADEWELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-890-1407
Mailing Address - Street 1:5102 N DAVIS HWY
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32503-2030
Mailing Address - Country:US
Mailing Address - Phone:850-549-4960
Mailing Address - Fax:
Practice Address - Street 1:5102 N DAVIS HWY
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32503-2030
Practice Address - Country:US
Practice Address - Phone:850-549-4960
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:INTERVENTIONAL THERAPEUTICS INSTITUTE LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-02-06
Last Update Date:2015-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty