Provider Demographics
NPI:1659304236
Name:FLORIDA ANESTHESIOLOGY & PAIN CLINIC PA
Entity Type:Organization
Organization Name:FLORIDA ANESTHESIOLOGY & PAIN CLINIC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RAVI
Authorized Official - Middle Name:
Authorized Official - Last Name:XAVIER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-628-5039
Mailing Address - Street 1:PO BOX 862622
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32886-2622
Mailing Address - Country:US
Mailing Address - Phone:407-720-3801
Mailing Address - Fax:407-720-3802
Practice Address - Street 1:933 LEE RD STE 105
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32810-5537
Practice Address - Country:US
Practice Address - Phone:407-720-3801
Practice Address - Fax:407-720-3802
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-08
Last Update Date:2017-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL251706000Medicaid
FL24343AOtherMEDICARE
FL24343Medicare ID - Type Unspecified