Provider Demographics
NPI:1982008215
Name:PRESTIGE ANESTHESIA LLC
Entity Type:Organization
Organization Name:PRESTIGE ANESTHESIA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:BARACK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-299-0900
Mailing Address - Street 1:6375 NW 120TH DR
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33076-1904
Mailing Address - Country:US
Mailing Address - Phone:954-800-7350
Mailing Address - Fax:954-800-7350
Practice Address - Street 1:6375 NW 120TH DR
Practice Address - Street 2:
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33076-1904
Practice Address - Country:US
Practice Address - Phone:954-800-7350
Practice Address - Fax:954-800-7350
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-15
Last Update Date:2014-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME111972207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty