MEDICARE: ST LUCIE ANESTHESIA ASSOCIATES LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207L00000X	Anesthesiology Physician

General Provider Information

NPI Number	:	1033634464
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ST LUCIE ANESTHESIA ASSOCIATES LLC

Provider Business Mailing Address
First Line	:	5565 CENTERVIEW DR STE 107
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27606-3563
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	555 SE 5TH AVE
Second Line	:
City	:	DELRAY BEACH
State	:	FL
Zip	:	33483-5212
Country	:	US
Telephone Number	:	800-437-2672
Fax Number	:

Authorized Official
Title or Position	:	OFFICER
Name	:	KATHLEEN KONDAS
Credential	:
Telephone Number	:	919-518-5000

Provider Enumeration Date	:	08/07/2017
Last Update Date	:	07/30/2021

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