Provider Demographics
NPI:1790043008
Name:BAY AREA CONSORTIUM OF ANESTHESIA SERVICES OF FLORIDA, LLC
Entity Type:Organization
Organization Name:BAY AREA CONSORTIUM OF ANESTHESIA SERVICES OF FLORIDA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING SPECIALIST
Authorized Official - Prefix:MISS
Authorized Official - First Name:MOHINI
Authorized Official - Middle Name:
Authorized Official - Last Name:DEWKINANDAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-822-7328
Mailing Address - Street 1:PO BOX 16786
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33416-6786
Mailing Address - Country:US
Mailing Address - Phone:954-822-7328
Mailing Address - Fax:
Practice Address - Street 1:1007 W COMMERCIAL BLVD
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33309-3107
Practice Address - Country:US
Practice Address - Phone:954-822-7328
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-25
Last Update Date:2012-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL111629174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty