Provider Demographics
NPI:1780971713
Name:AMSURG TAMPA BAY ANESTHESIA LLC
Entity type:Organization
Organization Name:AMSURG TAMPA BAY ANESTHESIA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SR DIRECTOR OF RCM TRANSFORMATION
Authorized Official - Prefix:MS
Authorized Official - First Name:JEAN
Authorized Official - Middle Name:
Authorized Official - Last Name:KOCHENDORDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-240-3795
Mailing Address - Street 1:1A BURTON HILLS BLVD
Mailing Address - Street 2:ATTN: PROVIDER ENROLLMENT
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37215-6187
Mailing Address - Country:US
Mailing Address - Phone:615-240-3809
Mailing Address - Fax:615-234-1809
Practice Address - Street 1:4809 N ARMENIA AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33603-1447
Practice Address - Country:US
Practice Address - Phone:813-872-9310
Practice Address - Fax:813-872-9311
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-28
Last Update Date:2023-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLFC673AMedicare PIN