Provider Demographics
NPI:1700545514
Name:BIBY ANESTHESIA LLC
Entity Type:Organization
Organization Name:BIBY ANESTHESIA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:NICHOLAS
Authorized Official - Last Name:IDA
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:847-989-0874
Mailing Address - Street 1:422 CYPRESS VIEW DR
Mailing Address - Street 2:
Mailing Address - City:OLDSMAR
Mailing Address - State:FL
Mailing Address - Zip Code:34677-4631
Mailing Address - Country:US
Mailing Address - Phone:847-989-0874
Mailing Address - Fax:
Practice Address - Street 1:2438 DR MARTIN LUTHER KING JR ST N
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33704-2750
Practice Address - Country:US
Practice Address - Phone:727-565-0740
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-09
Last Update Date:2021-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty