MEDICARE: ANESCO NORTH BROWARD 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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1699763862
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ANESCO NORTH BROWARD LLC

Provider Business Mailing Address
First Line	:	3601 W COMMERCIAL BLVD
Second Line	:	SUITES 4 AND 5
City	:	FT LAUDERDALE
State	:	FL
Zip	:	33309-3300
Country	:	US
Telephone Number	:	954-485-5666
Fax Number	:	954-484-1651

Provider Business Practice Location Address
First Line	:	3601 W COMMERCIAL BLVD
Second Line	:	SUITES 4 & 5
City	:	FT LAUDERDALE
State	:	FL
Zip	:	33309-3300
Country	:	US
Telephone Number	:	954-485-5666
Fax Number	:	954-484-1651

Authorized Official
Title or Position	:	VICE PRESIDENT
Name	:	PAUL KOLBERT
Credential	:	M.D.
Telephone Number	:	954-484-5666

Provider Enumeration Date	:	10/11/2005
Last Update Date	:	08/22/2020

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