Healthcare Provider Details

I. General information

NPI: 1073504346
Provider Name (Legal Business Name): MSC ANESTHESIA INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/04/2005
Last Update Date: 10/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 MANATEE AVE W
BRADENTON FL
34205-8610
US

IV. Provider business mailing address

601 MANATEE AVE W
BRADENTON FL
34205-8610
US

V. Phone/Fax

Practice location:
  • Phone: 941-745-2727
  • Fax: 941-745-2112
Mailing address:
  • Phone: 941-745-2727
  • Fax: 941-745-2112

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberHCC4600
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberHCC4600
License Number StateFL

VIII. Authorized Official

Name: DANA J WEINKLE
Title or Position: PRESIDENT
Credential: M.D.
Phone: 941-794-2020