Provider Demographics
NPI:1205989928
Name:ANESTHESIOLOGY ASSOCIATES OF THE GULF COAST LLC
Entity type:Organization
Organization Name:ANESTHESIOLOGY ASSOCIATES OF THE GULF COAST LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CRNA
Authorized Official - Prefix:
Authorized Official - First Name:DEDRA
Authorized Official - Middle Name:L
Authorized Official - Last Name:HERN
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:941-782-0102
Mailing Address - Street 1:6015 POINTE WEST BLVD
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34209-5532
Mailing Address - Country:US
Mailing Address - Phone:941-782-0102
Mailing Address - Fax:941-794-1863
Practice Address - Street 1:6015 POINTE WEST BLVD
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34209-5532
Practice Address - Country:US
Practice Address - Phone:941-782-0102
Practice Address - Fax:941-794-1863
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-18
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207L00000X, 207LP2900X
FLARNP2702393208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL=========OtherTAX ID