Provider Demographics
NPI:1770756256
Name:EAST COAST ANESTHESIA ASSOCIATES PA
Entity type:Organization
Organization Name:EAST COAST ANESTHESIA ASSOCIATES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:
Authorized Official - Last Name:INGRAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:863-357-6220
Mailing Address - Street 1:PO BOX 1106
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34995-1106
Mailing Address - Country:US
Mailing Address - Phone:863-357-6220
Mailing Address - Fax:863-357-6230
Practice Address - Street 1:6830 S US HIGHWAY 1
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34952-1410
Practice Address - Country:US
Practice Address - Phone:772-934-6443
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-07
Last Update Date:2013-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DN3309OtherMEDICARE RAILROAD
DN3309OtherMEDICARE RAILROAD