Provider Demographics
NPI:1184238669
Name:ST AUGUSTINE ANESTHESIA PARTNERS
Entity type:Organization
Organization Name:ST AUGUSTINE ANESTHESIA PARTNERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF ANCILLARY SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:JACQUELIN
Authorized Official - Middle Name:
Authorized Official - Last Name:KENNEDY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-483-5869
Mailing Address - Street 1:PO BOX 100227
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29202-3208
Mailing Address - Country:US
Mailing Address - Phone:904-730-1131
Mailing Address - Fax:904-717-2015
Practice Address - Street 1:212 SOUTHPARK CIR E
Practice Address - Street 2:
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32086-5135
Practice Address - Country:US
Practice Address - Phone:904-730-1131
Practice Address - Fax:904-717-2015
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-02
Last Update Date:2020-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty