Provider Demographics
NPI:1760567820
Name:ANESTHESIA ASSOCIATES OF TITUSVLLE
Entity Type:Organization
Organization Name:ANESTHESIA ASSOCIATES OF TITUSVLLE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:SPADE
Authorized Official - Middle Name:
Authorized Official - Last Name:WHITTEMORE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:321-268-2128
Mailing Address - Street 1:1504 GARDEN ST
Mailing Address - Street 2:
Mailing Address - City:TITUSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32796-3268
Mailing Address - Country:US
Mailing Address - Phone:321-268-2128
Mailing Address - Fax:321-268-0381
Practice Address - Street 1:1504 GARDEN ST
Practice Address - Street 2:
Practice Address - City:TITUSVILLE
Practice Address - State:FL
Practice Address - Zip Code:32796-3268
Practice Address - Country:US
Practice Address - Phone:321-268-2128
Practice Address - Fax:321-268-0381
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL40053Medicare ID - Type Unspecified