Provider Demographics
NPI:1770817702
Name:FAWCETT MEMORIAL HOSPITAL
Entity Type:Organization
Organization Name:FAWCETT MEMORIAL HOSPITAL
Other - Org Name:GULF COAST ANESTHESIA
Other - Org Type:Other Name
Authorized Official - Title/Position:ADMINISTATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SWAROOP
Authorized Official - Middle Name:
Authorized Official - Last Name:MUPPAVARAPU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:941-206-7251
Mailing Address - Street 1:5424 GRAND BLVD
Mailing Address - Street 2:
Mailing Address - City:NEW PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34652
Mailing Address - Country:US
Mailing Address - Phone:727-845-1736
Mailing Address - Fax:941-206-7250
Practice Address - Street 1:537 PARK ESTATES SQ
Practice Address - Street 2:
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34293-4181
Practice Address - Country:US
Practice Address - Phone:941-497-1949
Practice Address - Fax:941-497-1949
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GLUF COAST ANESTHESIA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-09-23
Last Update Date:2009-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2835962282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL45418OtherBCBSF
FL45418OtherBCBSF