Provider Demographics
NPI:1740609304
Name:BLD ANESTHESIA SERVICES LLC
Entity Type:Organization
Organization Name:BLD ANESTHESIA SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MGRM
Authorized Official - Prefix:
Authorized Official - First Name:BAMBI
Authorized Official - Middle Name:
Authorized Official - Last Name:DURIK
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP,CRNA
Authorized Official - Phone:321-704-2544
Mailing Address - Street 1:909 E MELBOURNE AVE
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32901-5578
Mailing Address - Country:US
Mailing Address - Phone:321-704-2544
Mailing Address - Fax:321-773-7239
Practice Address - Street 1:909 E MELBOURNE AVE
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901-5578
Practice Address - Country:US
Practice Address - Phone:321-704-2544
Practice Address - Fax:321-773-7239
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-10
Last Update Date:2014-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9300056367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty