Provider Demographics
NPI:1609109271
Name:ADVANTAGE ANESTHESIA LLC
Entity Type:Organization
Organization Name:ADVANTAGE ANESTHESIA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:OLIVER
Authorized Official - Middle Name:MARTIN
Authorized Official - Last Name:HASEK
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:850-235-8948
Mailing Address - Street 1:PO BOX 850001
Mailing Address - Street 2:DEPT 0629
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32885-0629
Mailing Address - Country:US
Mailing Address - Phone:850-235-8948
Mailing Address - Fax:
Practice Address - Street 1:202 DOCTORS DR
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32405-4454
Practice Address - Country:US
Practice Address - Phone:850-235-8948
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-14
Last Update Date:2012-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty
No367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Multi-Specialty