Healthcare Provider Details

I. General information

NPI: 1710928775
Provider Name (Legal Business Name): MID FLORIDA ANESTHESIA ASSOCIATES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2006
Last Update Date: 08/20/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7100 W CAMINO REAL SUITE 301
BOCA RATON FL
33433-5510
US

IV. Provider business mailing address

PO BOX 850001 DEPT 114
ORLANDO FL
32885-0114
US

V. Phone/Fax

Practice location:
  • Phone: 561-465-2598
  • Fax: 561-465-2599
Mailing address:
  • Phone: 772-337-7676
  • Fax: 772-264-2864

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number800018707
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number6167750002
License Number StateFL

VIII. Authorized Official

Name: JAY MARTIN
Title or Position: CEO
Credential:
Phone: 561-465-2598