Healthcare Provider Details

I. General information

NPI: 1790330694
Provider Name (Legal Business Name): PREMIER ANESTHESIA OF FLORIDA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/07/2019
Last Update Date: 01/17/2020
Certification Date: 01/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2020 59TH ST W
BRADENTON FL
34209-4604
US

IV. Provider business mailing address

500 NORTHRIDGE RD STE 330
ATLANTA GA
30350-3314
US

V. Phone/Fax

Practice location:
  • Phone: 404-941-1210
  • Fax:
Mailing address:
  • Phone: 404-941-1210
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code367H00000X
TaxonomyAnesthesiologist Assistant
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State

VIII. Authorized Official

Name: RICHARD POSEY
Title or Position: VICE PRESIDENT
Credential:
Phone: 404-941-1261