Provider Demographics
NPI:1801801527
Name:C R ANESTHESIA PA
Entity type:Organization
Organization Name:C R ANESTHESIA PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LEONARD
Authorized Official - Middle Name:
Authorized Official - Last Name:CALODNEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:352-795-4008
Mailing Address - Street 1:PO BOX 742318
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-2103
Mailing Address - Country:US
Mailing Address - Phone:855-250-6016
Mailing Address - Fax:855-206-8399
Practice Address - Street 1:6201 N SUNCOAST BLVD
Practice Address - Street 2:C/O SEVEN RIVERS REGIONAL
Practice Address - City:CRYSTAL RIVER
Practice Address - State:FL
Practice Address - Zip Code:34428
Practice Address - Country:US
Practice Address - Phone:317-614-9863
Practice Address - Fax:844-876-0873
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-30
Last Update Date:2017-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL374292000Medicaid
FL374292000Medicaid