Provider Demographics
NPI:1649745035
Name:LOVELOCK ANESTHESIA LLC
Entity Type:Organization
Organization Name:LOVELOCK ANESTHESIA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:WILFRED
Authorized Official - Middle Name:ROBIN
Authorized Official - Last Name:LOVELOCK
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:239-246-0512
Mailing Address - Street 1:1335 RAMBLEBROOK ST
Mailing Address - Street 2:
Mailing Address - City:MALABAR
Mailing Address - State:FL
Mailing Address - Zip Code:32950-4210
Mailing Address - Country:US
Mailing Address - Phone:239-246-0512
Mailing Address - Fax:
Practice Address - Street 1:8040 N WICKHAM RD
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32940-8367
Practice Address - Country:US
Practice Address - Phone:239-246-0512
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-11
Last Update Date:2022-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty