Provider Demographics
NPI:1295789956
Name:MORTON PLANT MEASE OUTPATIENT ANESTHESIOLOGY PA
Entity type:Organization
Organization Name:MORTON PLANT MEASE OUTPATIENT ANESTHESIOLOGY PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER RELATIONS
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:GUBBINI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:317-614-9863
Mailing Address - Street 1:PO BOX 198668
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30384-8668
Mailing Address - Country:US
Mailing Address - Phone:855-496-3580
Mailing Address - Fax:855-371-8492
Practice Address - Street 1:6600 MADISON ST
Practice Address - Street 2:BOX 803
Practice Address - City:NEW PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34652-1971
Practice Address - Country:US
Practice Address - Phone:772-842-8468
Practice Address - Fax:844-876-0873
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-19
Last Update Date:2017-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL367500000X, 207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty
No367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL21538OtherBLUE CROSS BLUE SHIELD
FL257274500Medicaid
FLCI6760OtherRAILROAD MEDICARE
FLK0003OtherGROUP MEDICARE PTAN NUMBER
FLK0003OtherGROUP MEDICARE PTAN NUMBER