Provider Demographics
NPI:1245012491
Name:ATHENA ANESTHESIA LLC
Entity type:Organization
Organization Name:ATHENA ANESTHESIA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:DURRETT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:941-539-7919
Mailing Address - Street 1:21289 WACISSA DR
Mailing Address - Street 2:
Mailing Address - City:VENICE
Mailing Address - State:FL
Mailing Address - Zip Code:34293-2696
Mailing Address - Country:US
Mailing Address - Phone:941-539-7919
Mailing Address - Fax:
Practice Address - Street 1:333 TAMIAMI TRL S STE 169-171
Practice Address - Street 2:
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34285-2402
Practice Address - Country:US
Practice Address - Phone:941-539-7919
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-20
Last Update Date:2023-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty