Provider Demographics
NPI:1720039746
Name:GULF-TO-BAY ANESTHESIOLOGY ASSOCIATES LLC
Entity Type:Organization
Organization Name:GULF-TO-BAY ANESTHESIOLOGY ASSOCIATES LLC
Other - Org Name:GULF TO BAY ANESTHESIOLOGY ASSOCIATES PA
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DEVANAND
Authorized Official - Middle Name:
Authorized Official - Last Name:MANGAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:813-514-6387
Mailing Address - Street 1:400 N ASHLEY DR
Mailing Address - Street 2:SUITE 1625
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33602-4300
Mailing Address - Country:US
Mailing Address - Phone:813-514-6387
Mailing Address - Fax:813-229-6801
Practice Address - Street 1:1 TAMPA GENERAL CIR
Practice Address - Street 2:SUITE A327
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33606-3571
Practice Address - Country:US
Practice Address - Phone:813-844-4434
Practice Address - Fax:813-844-4972
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-15
Last Update Date:2015-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL207L00000X, 207LC0200X, 207LP2900X, 207RC0200X, 208VP0000X
208100000X, 208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty
No207LC0200XAllopathic & Osteopathic PhysiciansAnesthesiologyCritical Care MedicineGroup - Multi-Specialty
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care MedicineGroup - Multi-Specialty
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Multi-Specialty
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL004944500Medicaid
FL40929OtherBCBS GROUP NUMBER
FL5250415OtherAETNA GROUP NUMBER
FL40929OtherBCBS GROUP NUMBER
FL5250415OtherAETNA GROUP NUMBER
FL004944500Medicaid