Provider Demographics
NPI:1942259890
Name:RIVERWALK ANESTHESIA LLC
Entity Type:Organization
Organization Name:RIVERWALK ANESTHESIA LLC
Other - Org Name:RIVERWALK ANESTHESIA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:EMILIE
Authorized Official - Middle Name:
Authorized Official - Last Name:DIGBY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:239-278-9955
Mailing Address - Street 1:6241 ARC WAY
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33966
Mailing Address - Country:US
Mailing Address - Phone:239-278-9955
Mailing Address - Fax:239-278-9966
Practice Address - Street 1:6241 ARC WAY
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33966
Practice Address - Country:US
Practice Address - Phone:239-278-9955
Practice Address - Fax:239-278-9966
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-09
Last Update Date:2007-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK8788Medicare ID - Type UnspecifiedMEDICARE GROUP PROVIDER #