Provider Demographics
NPI:1770691297
Name:SOUTH COAST ANESTHESIA
Entity type:Organization
Organization Name:SOUTH COAST ANESTHESIA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:KENNETH
Authorized Official - Last Name:KANE
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:760-297-1284
Mailing Address - Street 1:29724 PLATANUS DR
Mailing Address - Street 2:
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92026-5936
Mailing Address - Country:US
Mailing Address - Phone:760-297-1284
Mailing Address - Fax:760-297-1279
Practice Address - Street 1:29724 PLATANUS DR
Practice Address - Street 2:
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92026-5936
Practice Address - Country:US
Practice Address - Phone:760-297-1284
Practice Address - Fax:760-297-1279
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-25
Last Update Date:2010-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARN2955780313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CARN2955780Medicaid
CAWNA2382AMedicare ID - Type UnspecifiedMEDICARE ID
CAWNA002Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER