Provider Demographics
NPI:1578110219
Name:KIDD ANESTHESIA SERVICES, INC
Entity Type:Organization
Organization Name:KIDD ANESTHESIA SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:KIDD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-362-8954
Mailing Address - Street 1:4565 OLD CARRIAGE TRL
Mailing Address - Street 2:
Mailing Address - City:OVIEDO
Mailing Address - State:FL
Mailing Address - Zip Code:32765-8454
Mailing Address - Country:US
Mailing Address - Phone:407-362-8954
Mailing Address - Fax:
Practice Address - Street 1:152 TREEMONTE DR
Practice Address - Street 2:
Practice Address - City:ORANGE CITY
Practice Address - State:FL
Practice Address - Zip Code:32763-7953
Practice Address - Country:US
Practice Address - Phone:407-362-8954
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-19
Last Update Date:2019-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty