Provider Demographics
NPI:1598132508
Name:ST JOHN'S ANESTHESIA SERVICES
Entity Type:Organization
Organization Name:ST JOHN'S ANESTHESIA SERVICES
Other - Org Name:ST JOHN'S ANESTHESIA SERVICES, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:QUIGLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:239-481-8833
Mailing Address - Street 1:8901 CONFERENCE DR
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33919-4895
Mailing Address - Country:US
Mailing Address - Phone:239-481-8833
Mailing Address - Fax:
Practice Address - Street 1:8901 CONFERENCE DR
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33919-4895
Practice Address - Country:US
Practice Address - Phone:239-481-8833
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-25
Last Update Date:2015-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty