Provider Demographics
NPI:1710928775
Name:MID FLORIDA ANESTHESIA ASSOCIATES, INC.
Entity Type:Organization
Organization Name:MID FLORIDA ANESTHESIA ASSOCIATES, INC.
Other - Org Name:RESOLUTE PAIN SOLUTIONS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JAY
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-465-2598
Mailing Address - Street 1:PO BOX 850001
Mailing Address - Street 2:DEPT 114
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32885-0114
Mailing Address - Country:US
Mailing Address - Phone:772-337-7676
Mailing Address - Fax:772-264-2864
Practice Address - Street 1:7100 W CAMINO REAL
Practice Address - Street 2:SUITE 301
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33433-5510
Practice Address - Country:US
Practice Address - Phone:561-465-2598
Practice Address - Fax:561-465-2599
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RESOLUTE ANESTHESIA & PAIN SOLUTIONS, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-09
Last Update Date:2015-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL207LP2900X
FL800018707291U00000X
FL6167750002332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty
No291U00000XLaboratoriesClinical Medical Laboratory
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL33576OtherBCBS OF FLORIDA
FL377780400Medicaid
FLCH1211OtherRAILROAD MEDICARE
FL6167750002Medicare NSC
FLCH1211OtherRAILROAD MEDICARE