Provider Demographics
NPI:1609843275
Name:ANESTHESIA & PAIN CONSULTANTS OF SW FL
Entity Type:Organization
Organization Name:ANESTHESIA & PAIN CONSULTANTS OF SW FL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:HARLE
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:239-939-2622
Mailing Address - Street 1:12511 WORLD PLAZA LN
Mailing Address - Street 2:BUILDING 50
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-3991
Mailing Address - Country:US
Mailing Address - Phone:239-939-2622
Mailing Address - Fax:239-939-0151
Practice Address - Street 1:12511 WORLD PLAZA LN
Practice Address - Street 2:BUILDING 50
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33907-3991
Practice Address - Country:US
Practice Address - Phone:239-939-2622
Practice Address - Fax:239-939-0151
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-02
Last Update Date:2013-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0021827174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLCM3923OtherRAILROAD MEDICARE
FL059714700Medicaid
FL059714700Medicaid