Provider Demographics
NPI:1780651356
Name:UNIVERSITY ANESTHESIA
Entity Type:Organization
Organization Name:UNIVERSITY ANESTHESIA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:HARLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:239-939-2622
Mailing Address - Street 1:PO BOX 7346
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33911-7346
Mailing Address - Country:US
Mailing Address - Phone:239-939-2566
Mailing Address - Fax:239-939-0151
Practice Address - Street 1:13051 UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33907-5751
Practice Address - Country:US
Practice Address - Phone:239-939-2566
Practice Address - Fax:239-939-0151
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-02
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0024310174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
36167OtherBC BS FL
36167OtherBC BS FL
K4547Medicare PIN