Provider Demographics
NPI:1770363368
Name:GRACE ANESTHESIA SERVICES LLC
Entity type:Organization
Organization Name:GRACE ANESTHESIA SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JOY
Authorized Official - Middle Name:
Authorized Official - Last Name:WALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-351-0029
Mailing Address - Street 1:2301 SE 3RD AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34471-5105
Mailing Address - Country:US
Mailing Address - Phone:352-351-0029
Mailing Address - Fax:
Practice Address - Street 1:2301 SE 3RD AVE STE 200
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-5105
Practice Address - Country:US
Practice Address - Phone:352-351-0029
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-02
Last Update Date:2023-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty