Provider Demographics
NPI:1891231718
Name:PHOENIX ANESTHESIA PLLC
Entity Type:Organization
Organization Name:PHOENIX ANESTHESIA PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ANJANAYA PRASAD
Authorized Official - Middle Name:R
Authorized Official - Last Name:KORLIPARA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:772-489-5900
Mailing Address - Street 1:1331 N LAWNWOOD CIR
Mailing Address - Street 2:
Mailing Address - City:FORT PIERCE
Mailing Address - State:FL
Mailing Address - Zip Code:34950
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1331 N LAWNWOOD CIR
Practice Address - Street 2:
Practice Address - City:FORT PIERCE
Practice Address - State:FL
Practice Address - Zip Code:34950
Practice Address - Country:US
Practice Address - Phone:772-489-5900
Practice Address - Fax:772-489-2086
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-17
Last Update Date:2017-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty