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NPI Code Detail

MEDICARE: MARDI GRAS ANESTHESIA LLC

MEDICARE: MARDI GRAS 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
1367500000XCertified Registered Nurse Anesthetist9189562FL

General Provider Information

NPI Number : 1538490727
Entity Type Code : Organization
Provider Name (Legal Business Name) : MARDI GRAS ANESTHESIA LLC
Provider Business Mailing Address
First Line : 9746 WILSHIRE LAKES BLVD
Second Line :
City : NAPLES
State : FL
Zip : 34109-0752
Country : US
Telephone Number : 239-287-4376
Fax Number :
Provider Business Practice Location Address
First Line : 13195 METRO PKWY UNIT 12-16
Second Line :
City : FORT MYERS
State : FL
Zip : 33966-4810
Country : US
Telephone Number : 239-236-2215
Fax Number : 239-236-2219
Authorized Official
Title or Position : PRESIDENT
Name : MR. TROY ANTHONY MELANCON
Credential : C.R.N.A.
Telephone Number : 239-287-4376
Provider Enumeration Date : 01/27/2010
Last Update Date : 08/27/2024

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Directions to “MARDI GRAS ANESTHESIA LLC ” Practice Location

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