Healthcare Provider Details

I. General information

NPI: 1073001012
Provider Name (Legal Business Name): ANESTHESIA DYNAMICS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/25/2018
Last Update Date: 10/24/2022
Certification Date: 10/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

206 2ND ST E
BRADENTON FL
34208-1042
US

IV. Provider business mailing address

LB #8247 PO BOX 95000
PHILADELPHIA PA
19195-0001
US

V. Phone/Fax

Practice location:
  • Phone: 888-851-4642
  • Fax:
Mailing address:
  • Phone: 888-851-4642
  • Fax: 240-342-3837

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number State

VIII. Authorized Official

Name: LAURA ADKINS
Title or Position: EXEC. VP OF OPERATIONS
Credential:
Phone: 828-424-0869