Provider Demographics
NPI:1790975167
Name:CONTRACT ANESTHESIA SERVICES P A
Entity Type:Organization
Organization Name:CONTRACT ANESTHESIA SERVICES P A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:VAN
Authorized Official - Middle Name:DALE
Authorized Official - Last Name:BELL
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:727-698-3579
Mailing Address - Street 1:6698 29TH ST S
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33712-5514
Mailing Address - Country:US
Mailing Address - Phone:727-698-3579
Mailing Address - Fax:727-374-9146
Practice Address - Street 1:2821 PROCTOR RD
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34231-6443
Practice Address - Country:US
Practice Address - Phone:941-870-1872
Practice Address - Fax:941-870-1879
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-31
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP1360592367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLG2757OtherBLUE CROSS BLUE SHIELD
FL=========OtherTAX ID
FLAG074Medicare PIN