Provider Demographics
NPI:1245667542
Name:SUMMERLIN ANESTHESIA, INC.
Entity type:Organization
Organization Name:SUMMERLIN ANESTHESIA, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:GUTSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:239-466-8838
Mailing Address - Street 1:6094 14TH ST W
Mailing Address - Street 2:STE 107
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34207-4104
Mailing Address - Country:US
Mailing Address - Phone:941-360-1566
Mailing Address - Fax:941-358-9818
Practice Address - Street 1:4035 EVANS AVE
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33901-9308
Practice Address - Country:US
Practice Address - Phone:239-466-8838
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DAVID M. GUTSTEIN, M.D., P.A.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-10-01
Last Update Date:2014-05-23
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
FLE15781Medicare UPIN
FL376267000Medicaid
FL25220YMedicare PIN
FLK3099Medicare PIN