Provider Demographics
NPI:1790492908
Name:BLUE CLOUD ANESTHESIA, LLC
Entity Type:Organization
Organization Name:BLUE CLOUD ANESTHESIA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:LARSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-340-1840
Mailing Address - Street 1:182 INDUSTRIAL RD
Mailing Address - Street 2:
Mailing Address - City:GLEN ROCK
Mailing Address - State:PA
Mailing Address - Zip Code:17327-8626
Mailing Address - Country:US
Mailing Address - Phone:717-759-4375
Mailing Address - Fax:717-759-4336
Practice Address - Street 1:3599 UNIVERSITY BLVD S STE 604
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-4234
Practice Address - Country:US
Practice Address - Phone:904-842-1235
Practice Address - Fax:678-660-0120
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-28
Last Update Date:2022-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty