MEDICARE: EAST WEST ANESTHESIA 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	:	1194435651
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EAST WEST ANESTHESIA LLC

Provider Business Mailing Address
First Line	:	PO BOX 22562
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33622-2562
Country	:	US
Telephone Number	:	904-272-2020
Fax Number	:

Provider Business Practice Location Address
First Line	:	1855 EASTWEST PKWY
Second Line	:
City	:	FLEMING ISLAND
State	:	FL
Zip	:	32003-6348
Country	:	US
Telephone Number	:	904-272-2020
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	ERIC KING
Credential	:
Telephone Number	:	904-272-2020

Provider Enumeration Date	:	11/24/2022
Last Update Date	:	01/13/2023

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Directions to “EAST WEST ANESTHESIA LLC ” Practice Location

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